Provider Demographics
NPI:1841291010
Name:REESE, RICHARD GLENN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GLENN
Last Name:REESE
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 1:709 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4418207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0038919OtherDPS
TX080157301Medicaid
TX080157301Medicaid
TX8053J0Medicare ID - Type Unspecified
TXC20956Medicare UPIN