Provider Demographics
NPI:1013693969
Name:REIL, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:REIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 HEATHERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6409
Mailing Address - Country:US
Mailing Address - Phone:360-899-2002
Mailing Address - Fax:
Practice Address - Street 1:3015 SQUALICUM PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1906
Practice Address - Country:US
Practice Address - Phone:360-722-2092
Practice Address - Fax:360-788-6042
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WAPA61536054363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty