Individual
MR. JESSE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
MADIGAN ARMY MEDICAL CENTER, 9040 JACKSON, AVE, TACOMA, WA 98431
(253) 967-7656
Mailing address
MADIGAN ARMY MEDICAL CENTER, 9040 JACKSON AVE, JOINT BASE LEWIS-MCCHORD, WA 98431
(912) 368-3375
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA60698388
PA LICENSE
WA
Enumeration date
01/31/2006
Last updated
03/06/2024
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