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NPI Code Detail

MEDICARE: TANNER RAY REESE PA-C

MEDICARE: TANNER RAY REESE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA62480CA

General Provider Information

NPI Number : 1962108456
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANNER RAY REESE PA-C
Provider Business Mailing Address
First Line : 23922 DULZURA
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78261-2970
Country : US
Telephone Number : 385-238-0409
Fax Number :
Provider Business Practice Location Address
First Line : 900 THARP RD
Second Line :
City : YUBA CITY
State : CA
Zip : 95993-9159
Country : US
Telephone Number : 916-406-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2023
Last Update Date : 03/09/2023

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