Provider Demographics
NPI:1467581272
Name:REESE, JAMES JR (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:REESE
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:UNM HSC DEPARTMENT OF NEUROLOGY
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO; MSC 10-5620
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4517
Mailing Address - Fax:505-272-6692
Practice Address - Street 1:UNM HSC DEPARTMENT OF NEUROLOGY
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO; MSC 10-5620
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4517
Practice Address - Fax:505-272-6692
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.202328208000000X
MDD721192084N0402X
DCMD0392692084N0402X
NMMD2015-09092084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1191591OtherMEDICAID PROVIDER NUMBER