Provider Demographics
NPI:1043462104
Name:JOSE R. REYNA, JR., M.D., P.A.
Entity Type:Organization
Organization Name:JOSE R. REYNA, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:REYNALDO
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:505-820-2600
Mailing Address - Street 1:435 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE A-202
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7672
Mailing Address - Country:US
Mailing Address - Phone:505-820-2600
Mailing Address - Fax:505-820-2602
Practice Address - Street 1:435 SAINT MICHAELS DR
Practice Address - Street 2:SUITE A-202
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7672
Practice Address - Country:US
Practice Address - Phone:505-820-2600
Practice Address - Fax:505-820-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-88207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1048Medicaid
NMH04931Medicare UPIN