Provider Demographics
NPI:1437545894
Name:REICH, JOHN (PA-PAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:PA-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12748 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5634
Mailing Address - Country:US
Mailing Address - Phone:239-437-5500
Mailing Address - Fax:239-437-5507
Practice Address - Street 1:12748 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5634
Practice Address - Country:US
Practice Address - Phone:239-437-5500
Practice Address - Fax:239-437-5507
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPAX00009071OtherRX LIC