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General NPI Number Information
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NPI Number | 1720517873
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Entity Type | Individual
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Provider Name | JONATHAN ANDREW REIMER DO
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Gender | Male
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Dates
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Enumeration Date | 06/11/2017
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 2500 N STATE STREET OLD HOSPITAL 3 SOUTH, ROOM S376
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-6603
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 NORTH STATE STREET OLD HOSPITAL 3 SOUTH ROOM S376
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 617-997-3196
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 125.070609
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 33255
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License Number State | MS
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