Provider Demographics
NPI:1063031979
Name:HLAVKA, REID
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:HLAVKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WHASC, 1100 WILFORD HALL LOOP
Mailing Address - Street 2:BLDG. 4554, 59 MDW/GME
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:210-292-5188
Mailing Address - Fax:
Practice Address - Street 1:WHASC, 1100 WILFORD HALL LOOP
Practice Address - Street 2:BLDG. 4554, 59 MDW/GME
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program