Provider Demographics
NPI:1588607360
Name:REEL, JASON CARROLL (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CARROLL
Last Name:REEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3112
Mailing Address - Country:US
Mailing Address - Phone:936-632-5252
Mailing Address - Fax:936-632-5284
Practice Address - Street 1:200 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3112
Practice Address - Country:US
Practice Address - Phone:936-632-5252
Practice Address - Fax:936-632-5284
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1960213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218948201Medicaid
AR159972748Medicaid
ARU89816Medicare UPIN
TX218948201Medicaid
AR5W854Medicare ID - Type Unspecified
TXU89816Medicare UPIN