Provider Demographics
NPI:1235139890
Name:REAM, GAIL RAYLIEN (PA-C)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:RAYLIEN
Last Name:REAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6737
Mailing Address - Country:US
Mailing Address - Phone:806-293-8561
Mailing Address - Fax:806-293-8413
Practice Address - Street 1:1224 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MATADOR
Practice Address - State:TX
Practice Address - Zip Code:79244
Practice Address - Country:US
Practice Address - Phone:806-347-2641
Practice Address - Fax:806-347-2780
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191955701Medicaid
P11681Medicare UPIN
TX191955701Medicaid