Provider Demographics
NPI:1427049089
Name:REESOR, KENNETH E (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:REESOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E HAWKINS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8162
Mailing Address - Country:US
Mailing Address - Phone:903-758-2746
Mailing Address - Fax:903-758-7127
Practice Address - Street 1:323 E HAWKINS PKWY STE A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-8162
Practice Address - Country:US
Practice Address - Phone:903-758-2746
Practice Address - Fax:903-758-7127
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2752207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117870908Medicaid
TX117870905Medicaid