MEDICARE: MARK R REEVES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD2135021

General Provider Information

NPI Number	:	1467581926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK R REEVES MD

Provider Business Mailing Address
First Line	:	910 E REDD RD STE K # 167
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7348
Country	:	US
Telephone Number	:	915-581-3176
Fax Number	:	915-584-7659

Provider Business Practice Location Address
First Line	:	PEDRO VARELA 3007
Second Line	:	#14
City	:	CD. JUAREZ
State	:	CHIHUAHUA
Zip	:	32300
Country	:	MX
Telephone Number	:	915-549-2820
Fax Number	:	915-584-6759

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MARK RICHARD REEVES
Credential	:	M.D.
Telephone Number	:	915-581-3176

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	01/24/2012

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