Provider Demographics
NPI:1386941268
Name:REYNOLDS, ROSS A (PA-C)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 172263
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-2263
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 480
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5537
Practice Address - Country:US
Practice Address - Phone:720-441-4021
Practice Address - Fax:720-360-1195
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07199363A00000X
NC198994363A00000X
COPA.0005014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant