1902842313 NPI number — DR. RAYMOND R REESE M.D.

Table of content: DR. RAYMOND R REESE M.D. (NPI 1902842313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902842313 NPI number — DR. RAYMOND R REESE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REESE
Provider First Name:
RAYMOND
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902842313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 N ESPLANADE ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
CUERO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77954-4723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-275-2463
Provider Business Mailing Address Fax Number:
361-275-2431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 N ESPLANADE ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
CUERO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77954-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-275-3466
Provider Business Practice Location Address Fax Number:
361-275-2431
Provider Enumeration Date:
06/22/2006

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: 208D00000X , with the licence number:  C9110 , 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: 120302808 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120302805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120302807 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8P9301 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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