Provider Demographics
NPI:1265452379
Name:REAVES, JOHN EARL JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EARL
Last Name:REAVES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 CHACE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-7104
Mailing Address - Country:US
Mailing Address - Phone:205-733-7110
Mailing Address - Fax:205-733-7859
Practice Address - Street 1:1870 CHACE DR STE 160
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-7104
Practice Address - Country:US
Practice Address - Phone:205-733-7110
Practice Address - Fax:205-733-7859
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069653A207Q00000X
NC38828207Q00000X
ALMD.15271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138PAMedicaid
NC138PAOtherNCBCBS
NC138PAOtherNCBCBS
NC138PAOtherNCBCBS
NCE82045Medicare UPIN