Provider Demographics
NPI:1366532244
Name:REAMES, BRUCE ROBERT JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ROBERT
Last Name:REAMES
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W HOWARD CITY EDMORE RD
Mailing Address - Street 2:
Mailing Address - City:SIX LAKES
Mailing Address - State:MI
Mailing Address - Zip Code:48886-9739
Mailing Address - Country:US
Mailing Address - Phone:989-814-0627
Mailing Address - Fax:
Practice Address - Street 1:1131 E HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-9737
Practice Address - Country:US
Practice Address - Phone:989-427-5070
Practice Address - Fax:989-427-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102970Medicaid
MI102970Medicaid