Jason Reagor
Student in an Organized Health Care Education/Training Program in Albuquerque, NM. Individual provider (NPI-1).
NPI number1164058772
StatusActive
Last updated in NPPESMar 14, 2020
Details
- NPI
- 1164058772
- Entity type
- Individual (NPI-1)
- Name
- Jason Reagor
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 14, 2020
- Certification date
- Mar 14, 2020
- Last updated
- Mar 14, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
2211 Lomas Blvd NeAlbuquerque, NM 87106-2719
Phone 505-603-0999
Mailing address
500 Brighton LoopLos Alamos, NM 87547-3573
Phone 505-603-0999
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