Provider Demographics
NPI:1467432419
Name:REAVES, ERIK JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:JASON
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:UNIT 3230 BOX 337
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AA
Mailing Address - Zip Code:34031-0337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 3230 BOX 337
Practice Address - Street 2:
Practice Address - City:DPO
Practice Address - State:AA
Practice Address - Zip Code:34031-0337
Practice Address - Country:US
Practice Address - Phone:0115199-672-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-10492083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine