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General NPI Number Information
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NPI Number | 1063968741
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Entity Type | Individual
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Provider Name | ROBERT J REEVE
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Gender | Male
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1552 ADDISON AVE E STE A2
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 208-739-9961
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Fax | 208-739-9962
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Provider Business Mailing Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-4100
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 8271657
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License Number State | ID
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