Reynolds, Mark E.

Reynolds, Mark E. is an individual health care provider with primary practice located at 3712 22Nd St , Lubbock TX 79410-1312. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Reynolds, Mark E. can be contacted via phone (806) 795-5561.

Contact Information

Primary practice address
3712 22Nd St Lubbock TX 79410-1312
Phone: (806) 795-5561
Fax: (806) 793-9817
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 566392 Texas

Profile Details

NPI number 1629069422
LBN Legal business name Reynolds, Mark E.
Credentials FNAP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2005
Last updated Jun 27th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629069422 NPPES
Texas Other 0074JY BLUE CROSS BLUE SHIELD
Texas MEDICAID 148066702 BLUE CROSS BLUE SHIELD

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