Basic Information
| Provider Information | |||||||||
| NPI: | 1356447528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REAVES | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2867 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366522867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908158 | ||||||||
| FaxNumber: | 2516908853 | ||||||||
| Practice Location | |||||||||
| Address1: | 188 HOSPITAL DR STE 402 | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365322018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519901740 | ||||||||
| FaxNumber: | 2519901831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO.1567 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 363A00000X | PA-463 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 512-04537 | 01 | AL | BCBS OF AL | OTHER |