Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 5101017086 | MI |
N | 207PE0004X | Emergency Medical Services | 5101017086 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 5101017086 | MI |
N | 208D00000X | General Practice Physician | 5101017086 | MI |
NPI | 1114128089 |
---|---|
Provider Name | Dr. Jeffrey Joseph Reeves |
First Address | Winter Garden, FL 34787-5519 |
Second Address | Kissimmee, FL 34744-2316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 16/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12189224 | CAQH (01) |