Provider Demographics
NPI:1275558587
Name:REYES, MARTIN X (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:X
Last Name:REYES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8185
Mailing Address - Country:US
Mailing Address - Phone:972-293-5151
Mailing Address - Fax:972-981-3967
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8185
Practice Address - Country:US
Practice Address - Phone:972-293-5151
Practice Address - Fax:972-981-3967
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201308801Medicaid
TX201308802Medicaid
TX201308804Medicaid
TX201308803Medicaid
TX201308802Medicaid
TX201308801Medicaid
TX201308803Medicaid
TXTXB124749Medicare PIN
TX201308804Medicaid