Basic Information
Provider Information
NPI: 1033152855
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REASOL
FirstName: JOSE JEFFREY
MiddleName: TURTAL
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10452 SILVERDALE NW
Address2:  
City: SILVERDALE
State: WA
PostalCode: 98383
CountryCode: US
TelephoneNumber: 3603077300
FaxNumber: 3603077336
Practice Location
Address1: 10452 SILVERDALE WAY NW
Address2:  
City: SILVERDALE
State: WA
PostalCode: 983839411
CountryCode: US
TelephoneNumber: 3603077300
FaxNumber: 3603077336
Other Information
ProviderEnumerationDate: 06/13/2006
LastUpdateDate: 05/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD00045360WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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