Healthcare Provider Details

I. General information

NPI: 1316193170
Provider Name (Legal Business Name): AUSTIN S. REEVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 MCKNIGHT RD
TEXARKANA TX
75503-0921
US

IV. Provider business mailing address

4110 MCKNIGHT RD
TEXARKANA TX
75503-0921
US

V. Phone/Fax

Practice location:
  • Phone: 903-223-6000
  • Fax: 903-223-6016
Mailing address:
  • Phone: 903-223-6000
  • Fax: 903-223-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number178
License Number StateAR

VIII. Authorized Official

Name: AUSTIN S. REEVES
Title or Position: PODIATRIST
Credential:
Phone: 903-223-6000