Healthcare Provider Details

I. General information

NPI: 1902801798
Provider Name (Legal Business Name): MATTHEW S REEVES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S WOODSCREST DR
BLOOMINGTON IN
47401-5314
US

IV. Provider business mailing address

PO BOX 1329
BLOOMINGTON IN
47402-1329
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-6888
  • Fax: 812-353-5828
Mailing address:
  • Phone: 812-353-6888
  • Fax: 812-353-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number02002567A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02002567
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: