Individual
MR. JARED P. REISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4961 ROYAL GULF CIR, FORT MYERS, FL 33966-7006
(239) 687-4015
(321) 421-0393
Mailing address
1501 MCGREGOR RESERVE DR, FORT MYERS, FL 33901-9658
(407) 376-4976
(321) 421-0393
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3719
FL
363AM0700X
Medical Physician Assistant
PA3719
FL
363AS0400X
Surgical Physician Assistant
PA3719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021420100
—
FL
Enumeration date
07/15/2005
Last updated
01/05/2023
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