Individual
JON WELLINGTON 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
(336) 716-8190
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-8190
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2003-01404
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
200301404
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1425R
BCBS
—
01
—
190682
MEDCOST
—
05
—
3810008337
—
WV
05
—
5904515
—
NC
01
—
7897877
AETNA
—
01
—
808416
PARTNERS
—
01
—
P00397986
RR MEDICARE
—
05
—
Q0140H
—
SC
Enumeration date
07/03/2006
Last updated
09/08/2017
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