Provider Demographics
NPI:1376793851
Name:REEVES, DEREK CLARK JR (PA)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:CLARK
Last Name:REEVES
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:86-260 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86-260 FARRINGTON HIGHWAY
Practice Address - Street 2:WAIANAE COAST COMPREHENSIVE HEALTH CENTER ED
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3199
Practice Address - Country:US
Practice Address - Phone:808-697-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAMD 314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant