Provider Demographics
NPI:1205829074
Name:REYES, ANDRES M (MD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:M
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-781-2799
Mailing Address - Fax:772-781-2716
Practice Address - Street 1:10050 NW INNOVATION WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987
Practice Address - Country:US
Practice Address - Phone:772-286-1550
Practice Address - Fax:772-221-0569
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2019-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME100755207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL147LTOtherFLORIDA BLUE