Provider Demographics
NPI:1063522167
Name:BEST, LYDIA REASONOVER (MD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:REASONOVER
Last Name:BEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:MONIQUE
Other - Last Name:REASONOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 SPRING AVE STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1350
Practice Address - Country:US
Practice Address - Phone:214-835-3060
Practice Address - Fax:214-865-3070
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076458207Q00000X
TXQ2103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4685742Medicaid
MI0H208910OtherBCBSM GROUP PIN
MI700E031600OtherBCBSM GROUP PIN
MI0H208910OtherBCBSM GROUP PIN
H01914Medicare UPIN
MIP01530002Medicare PIN