Healthcare Provider Details

I. General information

NPI: 1467432419
Provider Name (Legal Business Name): ERIK JASON REAVES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3230 BOX 337
DPO AA
34031-0337
US

IV. Provider business mailing address

UNIT 3230 BOX 337
DPO AA
34031-0337
US

V. Phone/Fax

Practice location:
  • Phone: 01151996720190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberDOS-1049
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: