Individual
BARRY REESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
6610 BROOKS DR, TEMPLE, TX 76502-6301
(254) 289-2858
Mailing address
6610 BROOKS DR, TEMPLE, TX 76502-6301
(254) 289-2858
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00573
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA00573
LSA LICENSE
TX
Enumeration date
07/10/2014
Last updated
09/15/2016
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