Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G317680 | CA |
NPI | 1538173059 |
---|---|
Provider Name | Mr. James Lynn Reese |
First Address | Sonora, CA 95370 |
Second Address | Sonora, CA 95370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G317680 | (05) | CA |
756041926 | RR RETIREMENT (01) | CA |
A44863 | (02) |