Provider Demographics
NPI:1093899643
Name:REYES, MARTHA L (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E MCDOWELL RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2503
Mailing Address - Country:US
Mailing Address - Phone:602-466-2769
Mailing Address - Fax:
Practice Address - Street 1:926 E MCDOWELL RD
Practice Address - Street 2:SUITE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4556
Practice Address - Country:US
Practice Address - Phone:602-466-2769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204962Medicaid
AZZ112331Medicare PIN
AZ204962Medicaid