Healthcare Provider Details

I. General information

NPI: 1376503425
Provider Name (Legal Business Name): DOUGLAS ALLEN REEVES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 CLEMSON BLVD STE 100
SENECA SC
29678-4546
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-6000
  • Fax: 864-482-7000
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number19576
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: