Provider Demographics
NPI:1235659087
Name:REYNOLDS, DANIEL (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL RD
Mailing Address - Street 2:CALLER BOX C-268
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:CALLER BOX C-268
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-2871
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:605-755-4012
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC02533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program