Provider Demographics
NPI:1174600852
Name:REYNOLDS, VERNON D (DO)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:D
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 1:5336 FIREBUSH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5554
Mailing Address - Country:US
Mailing Address - Phone:614-457-8376
Mailing Address - Fax:
Practice Address - Street 1:5336 FIREBUSH LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5554
Practice Address - Country:US
Practice Address - Phone:614-457-8376
Practice Address - Fax:888-315-7905
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006761R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2129584Medicaid
OH2129584Medicaid