Provider Demographics
NPI:1104823897
Name:REYES, JOSE (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:REYES
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 1:309 STILLSON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3213
Mailing Address - Country:US
Mailing Address - Phone:203-366-8700
Mailing Address - Fax:203-367-8080
Practice Address - Street 1:309 STILLSON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3213
Practice Address - Country:US
Practice Address - Phone:203-366-8700
Practice Address - Fax:203-367-8080
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031786207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001317868Medicaid
CT001317868Medicaid
CT160001919Medicare ID - Type UnspecifiedMEDICARE #