Healthcare Provider Details

I. General information

NPI: 1265346126
Provider Name (Legal Business Name): WILD CHILD MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 AUSTIN HWY STE 102-435
SAN ANTONIO TX
78218-1730
US

IV. Provider business mailing address

1533 AUSTIN HWY STE 102-435
SAN ANTONIO TX
78218-1730
US

V. Phone/Fax

Practice location:
  • Phone: 281-813-3335
  • Fax:
Mailing address:
  • Phone: 281-813-3335
  • Fax: 816-575-7527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PATRICK TODD REEVES
Title or Position: CEO
Credential: MD
Phone: 281-813-3335