Provider Demographics
NPI:1225112659
Name:REYES, ALFONSO ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:ESTEBAN
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 1:943 WORTHINGTON WOODS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5743
Mailing Address - Country:US
Mailing Address - Phone:614-841-2420
Mailing Address - Fax:614-841-2427
Practice Address - Street 1:20320 NORTHWEST FWY STE 500
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5644
Practice Address - Country:US
Practice Address - Phone:281-586-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386130Medicaid
OHRE0898331Medicare ID - Type Unspecified
OHG73148Medicare UPIN