Provider Demographics
NPI:1902124209
Name:REYNOLDS, DAVID R (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:4640 W LLOYD EXPY
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6517
Practice Address - Country:US
Practice Address - Phone:812-422-4336
Practice Address - Fax:812-421-0994
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2024-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN07001161A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist