Provider Demographics
NPI:1043317209
Name:REEVES, STUART G (DPM)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:G
Last Name:REEVES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FLORIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3501
Mailing Address - Country:US
Mailing Address - Phone:916-395-1800
Mailing Address - Fax:916-395-5733
Practice Address - Street 1:902 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3501
Practice Address - Country:US
Practice Address - Phone:916-395-1800
Practice Address - Fax:916-395-5733
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4006213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40061Medicaid
CA000E40061Medicaid
CA5465800001Medicare NSC