Provider Demographics
NPI:1790706505
Name:REEVES, ROBERT BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRADLEY
Last Name:REEVES
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W VAN ASCHE LOOP
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4996
Practice Address - Country:US
Practice Address - Phone:479-966-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7623207X00000X
MO100174207X00000X
ARC-7011207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11464OtherANTHEM
200033678OtherRR MEDICARE
MO203311006Medicaid
KS100135410BMedicaid
MO203311006Medicaid
200033678OtherRR MEDICARE
SDS103607Medicare PIN