Provider Demographics
NPI:1083879357
Name:REYES, NATHANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:A
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MSC 030
Mailing Address - Street 2:PO BOX 29072
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9072
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-324-5664
Practice Address - Fax:520-324-4156
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2021-09-16
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Provider Licenses
StateLicense IDTaxonomies
AZ47672207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042339Medicaid