Provider Demographics
NPI:1508139965
Name:REEDER, DESIRAE J (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIRAE
Middle Name:J
Last Name:REEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DESIRAE
Other - Middle Name:J
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 W SANFORD ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-7086
Mailing Address - Country:US
Mailing Address - Phone:817-569-5350
Mailing Address - Fax:
Practice Address - Street 1:601 W SANFORD ST
Practice Address - Street 2:STE 201
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-7086
Practice Address - Country:US
Practice Address - Phone:817-569-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN83392084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DV700OtherBCBS
TX307125002Medicaid
TX307125003Medicaid
TX298373YRK5Medicare PIN