Organization
IAN JOHN REYNOLDS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE I GODFREY (OFFICE MANAGER)
(281) 332-9676
Entity
Organization
Contact information
Practice address
450 MEDICAL CENTER BLVD, SUITE 206, WEBSTER, TX 77598
(281) 332-9676
(281) 338-7723
Mailing address
450 MEDICAL CENTER BLVD, SUITE 206, WEBSTER, TX 77598
(281) 332-9676
(281) 338-7723
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MDF8994
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099487301
—
TX
Enumeration date
04/12/2006
Last updated
10/04/2010
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