Healthcare Provider Details

I. General information

NPI: 1285660431
Provider Name (Legal Business Name): GARRY PAUL REAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 LEMONE INDUSTRIAL BLVD
COLUMBIA MO
65201-8246
US

IV. Provider business mailing address

3300 LEMONE INDUSTRIAL BLVD
COLUMBIA MO
65201-8246
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-1531
  • Fax: 573-449-3458
Mailing address:
  • Phone: 573-443-1531
  • Fax: 573-449-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR9851
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: