1366615643 NPI number — MS. ERIN A REESE M.D.

Table of content: MS. ERIN A REESE M.D. (NPI 1366615643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366615643 NPI number — MS. ERIN A REESE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REESE
Provider First Name:
ERIN
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AUSBURY
Provider Other First Name:
ERIN
Provider Other Middle Name:
ADAIRE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366615643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19222 STONEHUE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-890-1952
Provider Business Mailing Address Fax Number:
210-396-7736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19222 STONEHUE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-890-1952
Provider Business Practice Location Address Fax Number:
210-396-7736
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  N8711 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01180888 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134752810 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DP748 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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