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General NPI Number Information
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NPI Number | 1366532244
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Entity Type | Individual
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Provider Name | BRUCE ROBERT REAMES JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1131 E HOWARD CITY EDMORE RD
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City | EDMORE
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State | MI
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Zip | 48829-9737
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Country | US
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Telephone | 989-427-5070
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Fax | 989-427-3690
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Provider Business Mailing Address
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Address Line | 4500 W HOWARD CITY EDMORE RD
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City | SIX LAKES
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State | MI
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Zip | 48886-9739
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Country | US
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Telephone | 989-814-0627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601001291
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License Number State | MI
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