Provider Demographics
NPI:1891776258
Name:REILLY, JAMES FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANCIS
Last Name:REILLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:209
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1477
Mailing Address - Country:US
Mailing Address - Phone:818-949-4494
Mailing Address - Fax:818-949-7330
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:209
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-949-4494
Practice Address - Fax:818-949-7330
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51287207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG51287BMedicare ID - Type UnspecifiedPPIN
CAD08976Medicare UPIN
CAY01828Medicare UPIN
CAW16885Medicare ID - Type UnspecifiedGPIN