MEDICARE: DR. REBECCA JEAN REILLY-NIVERS D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	1618	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265420053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA JEAN REILLY-NIVERS D.P.M.

Provider Business Mailing Address
First Line	:	12705 RIO BRAVO ST
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-4073
Country	:	US
Telephone Number	:	832-526-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	12705 RIO BRAVO ST
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-4073
Country	:	US
Telephone Number	:	281-369-7064
Fax Number	:	281-369-7073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/09/2013

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