Healthcare Provider Details

I. General information

NPI: 1396737540
Provider Name (Legal Business Name): JOHN W REEVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GREENWOOD RD
SHREVEPORT LA
71103-3908
US

IV. Provider business mailing address

PO BOX 32600
SHREVEPORT LA
71130-2600
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-4500
  • Fax: 318-212-4143
Mailing address:
  • Phone: 318-212-4877
  • Fax: 318-212-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number06231R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: