Provider Demographics
NPI:1740415280
Name:REEVES II, WILBERT B (IDMT)
Entity Type:Individual
Prefix:
First Name:WILBERT
Middle Name:B
Last Name:REEVES II
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:WILBERT
Other - Middle Name:B
Other - Last Name:REEVES II
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDMT
Mailing Address - Street 1:225 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5707
Mailing Address - Country:US
Mailing Address - Phone:850-884-1135
Mailing Address - Fax:850-884-1241
Practice Address - Street 1:225 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5707
Practice Address - Country:US
Practice Address - Phone:850-884-1136
Practice Address - Fax:850-884-1241
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians