Lawrence Lewis Reynolds, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

1164 Issued in AK

Practice address

252 Seldovia St
Seldovia, AK 99663-0210

Phone

(907) 234-7825

Fax

(907) 234-7825

NPI assigned

Nov 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Health Imaging Centers

  • Mammography Clinic/Center
  • Seldovia, AK
  • NPI 1184174831
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417020348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DRAWER J",
            "address_2": "252 SELDOVIA ST",
            "city": "SELDOVIA",
            "state": "AK",
            "postal_code": "996630210",
            "telephone_number": "907-234-7825",
            "fax_number": "907-234-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 SELDOVIA ST",
            "city": "SELDOVIA",
            "state": "AK",
            "postal_code": "996630210",
            "telephone_number": "907-234-7825",
            "fax_number": "907-234-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "LAWRENCE",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AK",
            "license": "1164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1164",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "0200641039",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alison Godwin, LMT
• La Maestra Family Clinic, Inc.
• Lilli Ann Ohse, LPC
• Melissa R Peterson
• Art Prennace, LPC
• Mary Anne Wilson, ANP

• General Practice Physician in Seldovia, AK
• Providers in Seldovia, AK by specialty
• General Practice Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.