Provider Demographics
NPI:1427164417
Name:REEL, JOHN EMERSON JR (PA-C, MPAS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EMERSON
Last Name:REEL
Suffix:JR
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1138
Mailing Address - Country:US
Mailing Address - Phone:610-377-7174
Mailing Address - Fax:610-377-4758
Practice Address - Street 1:281 N 12TH ST
Practice Address - Street 2:SUITE C-2
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1101
Practice Address - Country:US
Practice Address - Phone:610-377-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000910L363A00000X
PAMA-000910-L363AM0700X
PAOA002124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA035786Medicare PIN
PAP98753Medicare UPIN