Provider Demographics
NPI:1679757652
Name:GRAVES, REESE CABOT (MD)
Entity type:Individual
Prefix:DR
First Name:REESE
Middle Name:CABOT
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1410 E RENNER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2227
Mailing Address - Country:US
Mailing Address - Phone:972-234-3311
Mailing Address - Fax:972-272-5969
Practice Address - Street 1:1410 E RENNER RD STE 201
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2227
Practice Address - Country:US
Practice Address - Phone:972-312-3311
Practice Address - Fax:972-669-8072
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8006207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204061001Medicaid
TXP00910194Medicare PIN
TX8L15508Medicare PIN