Individual
JOHN EDWARD REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
200200984
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
200200984
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1313N
BCBS
—
05
—
2004776000
—
WV
01
—
50088605
RR MEDICARE
—
05
—
5719241
—
VA
01
—
7877707
AETNA
—
01
—
800198
PARTNERS
—
05
—
891313N
—
NC
01
—
B8591
MEDCOST
—
05
—
Q0098D
—
SC
Enumeration date
12/14/2005
Last updated
09/08/2017
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