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General NPI Number Information
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NPI Number | 1538347844
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Entity Type | Individual
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Provider Name | JASON MICHAEL REESE PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 353 FAIRMONT BLVD
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City | RAPID CITY
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State | SD
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Zip | 57701-7375
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Country | US
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Telephone | 605-771-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5 PLEASANT VIEW DR
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City | EAST GRANBY
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State | CT
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Zip | 06026-9719
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Country | US
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Telephone | 203-627-0047
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Fax | 860-714-8096
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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 | 0110009548
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 002041
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00773400
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1546
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License Number State | SD
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