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General NPI Number Information
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NPI Number | 1043096480
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Entity Type | Individual
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Provider Name | SAMUEL MILFRED REEVES PA
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Gender | Male
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 710 15TH ST E
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City | TUSCALOOSA
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State | AL
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Zip | 35401-3236
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Country | US
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Telephone | 205-526-2053
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 CAHABA BEACH RD
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City | BIRMINGHAM
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State | AL
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Zip | 35242-5225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.2228
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License Number State | AL
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