Provider Demographics
NPI:1205084555
Name:REEVES, RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 W REYNOSA AVE
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1630
Mailing Address - Country:US
Mailing Address - Phone:254-893-5895
Mailing Address - Fax:254-893-5222
Practice Address - Street 1:135 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1804
Practice Address - Country:US
Practice Address - Phone:254-965-2810
Practice Address - Fax:254-965-5440
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10026636207Q00000X
TXN8712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282560602Medicaid
TXTXB137725Medicare PIN
TX282560602Medicaid