Healthcare Provider Details

I. General information

NPI: 1366532244
Provider Name (Legal Business Name): BRUCE ROBERT REAMES JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 E HOWARD CITY EDMORE RD
EDMORE MI
48829-9737
US

IV. Provider business mailing address

4500 W HOWARD CITY EDMORE RD
SIX LAKES MI
48886-9739
US

V. Phone/Fax

Practice location:
  • Phone: 989-427-5070
  • Fax: 989-427-3690
Mailing address:
  • Phone: 989-814-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: