Provider Demographics
NPI:1356447528
Name:REAVES, CHAD DAVID (DO)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DAVID
Last Name:REAVES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-690-8853
Practice Address - Street 1:188 HOSPITAL DR STE 402
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2018
Practice Address - Country:US
Practice Address - Phone:251-990-1740
Practice Address - Fax:251-990-1831
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1567207R00000X
ALPA-463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-04537OtherBCBS OF AL