Provider Demographics
NPI:1245267400
Name:NORMAN H. REEVES,DPM PODIATRY CORP
Entity type:Organization
Organization Name:NORMAN H. REEVES,DPM PODIATRY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-337-9113
Mailing Address - Street 1:1530 S IMPERIAL AVE
Mailing Address - Street 2:P.O. BOX 4056
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4241
Mailing Address - Country:US
Mailing Address - Phone:760-337-9113
Mailing Address - Fax:760-337-9108
Practice Address - Street 1:1530 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4241
Practice Address - Country:US
Practice Address - Phone:760-337-9113
Practice Address - Fax:760-337-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1848213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE18480Medicare ID - Type Unspecified
CAT11076Medicare UPIN