Healthcare Provider Details

I. General information

NPI: 1225440894
Provider Name (Legal Business Name): JERRY REEVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 W OQUENDO RD SUITE 102
LAS VEGAS NV
89118-2539
US

IV. Provider business mailing address

18 VINTAGE CT
LAS VEGAS NV
89113-1352
US

V. Phone/Fax

Practice location:
  • Phone: 702-933-7318
  • Fax: 702-968-4501
Mailing address:
  • Phone: 702-743-1964
  • Fax: 702-873-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number121
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: