Provider Demographics
NPI:1366492233
Name:REEVE, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:REEVE
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 1:600 S MAIN ST STE 3.600
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2410
Mailing Address - Country:US
Mailing Address - Phone:817-870-9990
Mailing Address - Fax:817-334-0255
Practice Address - Street 1:600 S MAIN ST STE 3.600
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2410
Practice Address - Country:US
Practice Address - Phone:817-870-9990
Practice Address - Fax:817-334-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032197801Medicaid
TXBA42OtherBLUE CROSS BLUE SHIELD
TX00BA42Medicare ID - Type Unspecified
TX032197801Medicaid