MEDICARE: MR. BRUCE ROBERT REAMES JR. PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601001291	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366532244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE ROBERT REAMES JR. PA-C

Provider Business Mailing Address
First Line	:	4500 W HOWARD CITY EDMORE RD
Second Line	:
City	:	SIX LAKES
State	:	MI
Zip	:	48886-9739
Country	:	US
Telephone Number	:	989-814-0627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 E HOWARD CITY EDMORE RD
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-9737
Country	:	US
Telephone Number	:	989-427-5070
Fax Number	:	989-427-3690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/09/2007

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