1376658443 NPI number — DR. DAVID REEVES MD

Table of content: DR. DAVID REEVES MD (NPI 1376658443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376658443 NPI number — DR. DAVID REEVES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEVES
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REEVES
Provider Other First Name:
DAVID
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376658443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39502-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-868-3684
Provider Business Mailing Address Fax Number:
228-868-3795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20091 PINEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39560-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-868-3684
Provider Business Practice Location Address Fax Number:
228-868-3795
Provider Enumeration Date:
08/20/2006

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: 208000000X , with the licence number:  08792 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00117488 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".