Provider Demographics
NPI:1285660431
Name:REAMS, GARRY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:PAUL
Last Name:REAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 LEMONE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8246
Mailing Address - Country:US
Mailing Address - Phone:573-443-1531
Mailing Address - Fax:573-449-3458
Practice Address - Street 1:3300 LEMONE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8246
Practice Address - Country:US
Practice Address - Phone:573-443-1531
Practice Address - Fax:573-449-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9851207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201822921Medicaid
MO201822921Medicaid
MO000004079Medicare ID - Type Unspecified