Provider Demographics
NPI:1538173059
Name:REESE, JAMES LYNN (MD FACS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LYNN
Last Name:REESE
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:795 MORNING STAR DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-533-2545
Mailing Address - Fax:209-533-0924
Practice Address - Street 1:795 MORNING STAR DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-533-2545
Practice Address - Fax:209-533-0924
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG317680207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA756041926OtherRR RETIREMENT
CA00G317680Medicaid
CA756041926OtherRR RETIREMENT
CA00G317680Medicare PIN