Provider Demographics
NPI:1679757652
Name:GRAVES, REESE CABOT (MD)
Entity Type:Individual
Prefix:DR
First Name:REESE
Middle Name:CABOT
Last Name:GRAVES
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 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-272-6554
Mailing Address - Fax:972-272-5969
Practice Address - Street 1:1410 E RENNER RD STE 201
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2227
Practice Address - Country:US
Practice Address - Phone:972-312-3311
Practice Address - Fax:972-669-8072
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8006207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204061001Medicaid
TXP00910194Medicare PIN
TX8L15508Medicare PIN