Provider Demographics
NPI:1902842313
Name:REESE, RAYMOND R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:REESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2500 N ESPLANADE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-4723
Mailing Address - Country:US
Mailing Address - Phone:361-275-2463
Mailing Address - Fax:361-275-2431
Practice Address - Street 1:2500 N ESPLANADE ST
Practice Address - Street 2:STE 102
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4723
Practice Address - Country:US
Practice Address - Phone:361-275-3466
Practice Address - Fax:361-275-2431
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC9110208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120302808Medicaid
TX120302805Medicaid
TX120302807Medicaid
TX8P9301OtherBLUE CROSS BLUE SHIELD OF
TX334226YK7YMedicare PIN
TX120302807Medicaid