Provider Demographics
NPI:1275611501
Name:REAMS, JERRY L (LMP)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:REAMS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307B NE 78TH ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:136-057-3193
Mailing Address - Fax:136-057-1014
Practice Address - Street 1:1307B NE 78TH ST.
Practice Address - Street 2:SUITE 3
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-573-1933
Practice Address - Fax:360-571-0143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020315171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor