Provider Demographics
NPI:1407815251
Name:EUBANKS, REAVIS THAYER (MD)
Entity Type:Individual
Prefix:DR
First Name:REAVIS
Middle Name:THAYER
Last Name:EUBANKS
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 1:36 ALL SOULS CRES
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2670
Mailing Address - Country:US
Mailing Address - Phone:828-277-5919
Mailing Address - Fax:828-277-5920
Practice Address - Street 1:36 ALL SOULS CRES
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2670
Practice Address - Country:US
Practice Address - Phone:828-277-5919
Practice Address - Fax:828-277-5920
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-30884Medicaid
NC89-30884Medicaid
NCC80859Medicare UPIN