Provider Demographics
NPI:1952339434
Name:REIMERS, JEFFREY L (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:REIMERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-6800
Mailing Address - Fax:208-302-6855
Practice Address - Street 1:1510 12TH AVE RD
Practice Address - Street 2:STE 200
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2834
Practice Address - Country:US
Practice Address - Phone:208-302-6800
Practice Address - Fax:208-302-6855
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID004382900Medicaid
ID1666428Medicare ID - Type Unspecified
ID004382900Medicaid