Provider Demographics
NPI:1376658443
Name:REEVES, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:REEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-868-3684
Mailing Address - Fax:228-868-3795
Practice Address - Street 1:20091 PINEVILLE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3208
Practice Address - Country:US
Practice Address - Phone:228-868-3684
Practice Address - Fax:228-868-3795
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117488Medicaid
MS00117488Medicaid
MS$$$$$$$$$AOtherBCBS
MS$$$$$$$$$AOtherBCBS
MS370000201Medicare ID - Type Unspecified
MS00117488Medicaid
MS302I375959Medicare PIN