Healthcare Provider Details

I. General information

NPI: 1376658443
Provider Name (Legal Business Name): DAVID REEVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID REEVES M.D.

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20091 PINEVILLE RD
LONG BEACH MS
39560-3208
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-868-3684
  • Fax: 228-868-3795
Mailing address:
  • Phone: 228-868-3684
  • Fax: 228-868-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number08792
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: