Provider Demographics
NPI:1902280266
Name:REYNOLDS, DONALD R SR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
Last Name:REYNOLDS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DON
Other - Middle Name:R
Other - Last Name:REYNOLDS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1464 S BISCAY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4443
Mailing Address - Country:US
Mailing Address - Phone:720-353-6103
Mailing Address - Fax:
Practice Address - Street 1:1464 S BISCAY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4443
Practice Address - Country:US
Practice Address - Phone:720-353-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator