Provider Demographics
NPI:1366244394
Name:REYNOLDS, TYLER (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
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 1:220 TCHEFUNCTE PARC CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9777
Mailing Address - Country:US
Mailing Address - Phone:985-951-0578
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3020
Practice Address - Country:US
Practice Address - Phone:504-503-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program