Provider Demographics
NPI:1336459254
Name:REICHOLD, ADAM COLTER (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:COLTER
Last Name:REICHOLD
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:937 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93246-5004
Mailing Address - Country:US
Mailing Address - Phone:559-998-2657
Mailing Address - Fax:559-998-2465
Practice Address - Street 1:937 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93246-5004
Practice Address - Country:US
Practice Address - Phone:559-998-2657
Practice Address - Fax:559-998-2465
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA21914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant