Individual
TRACEY REEVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
520 S EAGLE RD STE 1241, MERIDIAN, ID 83642-6355
(208) 381-6930
(208) 381-6931
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-1159
ID
363AS0400X
Surgical Physician Assistant
PA156906
OR
Other
Enumeration date
07/31/2008
Last updated
08/30/2023
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