Individual
JASON REAGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 603-0999
Mailing address
500 BRIGHTON LOOP, LOS ALAMOS, NM 87547-3573
(505) 603-0999
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/14/2020
Last updated
03/14/2020
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