Healthcare Provider Details

I. General information

NPI: 1326633652
Provider Name (Legal Business Name): REID TOWNSEND RIVERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 05/14/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 80 BOX 5217
APO AP
96368-5217
US

IV. Provider business mailing address

OPC 80 BOX 5217
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU1759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: