Healthcare Provider Details

I. General information

NPI: 1467581272
Provider Name (Legal Business Name): JAMES REESE JR. MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM HSC DEPARTMENT OF NEUROLOGY 1 UNIVERSITY OF NEW MEXICO; MSC 10-5620
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

UNM HSC DEPARTMENT OF NEUROLOGY 1 UNIVERSITY OF NEW MEXICO; MSC 10-5620
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4517
  • Fax: 505-272-6692
Mailing address:
  • Phone: 505-272-4517
  • Fax: 505-272-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.202328
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberD72119
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD039269
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD2015-0909
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: