Provider Demographics
NPI:1174706006
Name:REYNOLDS, CRAIG ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4628
Mailing Address - Country:US
Mailing Address - Phone:303-985-3303
Mailing Address - Fax:303-232-8585
Practice Address - Street 1:3280 WADSWORTH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4628
Practice Address - Country:US
Practice Address - Phone:303-985-3303
Practice Address - Fax:303-232-8585
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist