Provider Demographics
NPI:1366615643
Name:REESE, ERIN A (MD)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:A
Last Name:REESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:ADAIRE
Other - Last Name:AUSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19222 STONEHUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-890-1952
Mailing Address - Fax:210-396-7736
Practice Address - Street 1:19222 STONEHUE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-890-1952
Practice Address - Fax:210-396-7736
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8711207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01180888OtherRAILROAD MEDICARE
TX134752810Medicaid
TX8DP748OtherBCBSTX
TX8DP748OtherBCBSTX
200329YLLWMedicare PIN
TX8DP748OtherBCBSTX
TX134752808Medicaid