Provider Demographics
NPI:1164544656
Name:REYES, GUILLERMO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:ANTONIO
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 1:8093 ECKHERT RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2637
Mailing Address - Country:US
Mailing Address - Phone:210-949-1300
Mailing Address - Fax:210-949-1475
Practice Address - Street 1:8093 ECKHERT RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2637
Practice Address - Country:US
Practice Address - Phone:210-949-1300
Practice Address - Fax:210-949-1475
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ01563207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103755802Medicaid
TX103755802Medicaid