Provider Demographics
NPI:1467581926
Name:MARK R REEVES MD
Entity Type:Organization
Organization Name:MARK R REEVES MD
Other - Org Name:INTERNATIONAL MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-581-3176
Mailing Address - Street 1:910 E REDD RD STE K # 167
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7348
Mailing Address - Country:US
Mailing Address - Phone:915-581-3176
Mailing Address - Fax:915-584-7659
Practice Address - Street 1:PEDRO VARELA 3007
Practice Address - Street 2:#14
Practice Address - City:CD. JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32300
Practice Address - Country:MX
Practice Address - Phone:915-549-2820
Practice Address - Fax:915-584-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2135021208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty