Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101256335 | VA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | LL30816 | SC |
N | 207YP0228X | Pediatric Otolaryngology | 56411 | MN |
NPI | 1285800573 |
---|---|
Provider Name | Dr. Travis Daniel Reeves |
First Address | Roanoke, VA 24016-4955 |
Second Address | Roanoke, VA 24016-4955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 06/01/2021 |