Individual
DR. MICHAEL D REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12266 DEPAUL DR., SUITE 305, BRIDGETON, MO 63044-2516
(314) 770-0991
(314) 770-0692
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R1J28
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202545612
—
MO
01
—
770001238
RAILROAD MEDICARE
MO
Enumeration date
08/13/2006
Last updated
10/26/2020
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