Individual
DR. JOHN R REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
155 SPURWINK AVE, CAPE ELIZABETH, ME 04107-9604
(207) 767-2174
(207) 767-1348
Mailing address
39 WALLACE AVE, SOUTH PORTLAND, ME 04106-6143
(207) 761-0650
(207) 761-8198
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
013547
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284170099
—
ME
Enumeration date
07/10/2006
Last updated
05/08/2009
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