Individual
MR. SAMUEL D. MCREYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
537 UNION AVE, GRANTS PASS, OR 97527-5543
(541) 479-6777
(541) 479-6779
Mailing address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-4281
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA60914100
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
881062
—
AZ
Enumeration date
06/24/2006
Last updated
02/18/2020
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