Individual
NICHOLAS DANIEL REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-1735
(502) 852-6056
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
(502) 587-4784
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
321248
NY
207L00000X
Anesthesiology Physician
Primary
54375
KY
207LP3000X
Pediatric Anesthesiology Physician
2019037032
MO
207LP3000X
Pediatric Anesthesiology Physician
321248
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300042676
—
IN
05
—
7100692760
—
KY
Enumeration date
04/01/2013
Last updated
02/08/2023
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