Provider Demographics
NPI:1285662635
Name:REEVES, TERRANCE ROLAND (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:ROLAND
Last Name:REEVES
Suffix:
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 1:7552 NAVARRE PKWY UNIT 21
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7308
Mailing Address - Country:US
Mailing Address - Phone:850-837-8005
Mailing Address - Fax:850-837-4352
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 21
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7308
Practice Address - Country:US
Practice Address - Phone:850-837-8005
Practice Address - Fax:850-837-4352
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67749207QA0401X, 2083A0300X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269452200Medicaid
FL27484OtherBCBS
FL3814855Medicare PIN
G04920Medicare UPIN
FL27484XMedicare PIN