Provider Demographics
NPI:1942424478
Name:RICHARD GLENN REESE MDPA
Entity Type:Organization
Organization Name:RICHARD GLENN REESE MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-688-0031
Mailing Address - Street 1:709 W LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3248
Mailing Address - Country:US
Mailing Address - Phone:432-688-0031
Mailing Address - Fax:432-688-0035
Practice Address - Street 1:709 W LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3248
Practice Address - Country:US
Practice Address - Phone:432-688-0031
Practice Address - Fax:432-688-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080157301Medicaid
TX134243801Medicaid
TX00214NOtherBCBS
TX8053J0Medicare ID - Type Unspecified
TX00214NOtherBCBS
TXP55250Medicare UPIN