Provider Demographics
NPI:1336146406
Name:REYES, ROY R (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:R
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 1:4785 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2497
Mailing Address - Country:US
Mailing Address - Phone:850-476-9691
Mailing Address - Fax:850-476-0777
Practice Address - Street 1:4785 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2497
Practice Address - Country:US
Practice Address - Phone:850-476-9691
Practice Address - Fax:850-476-0777
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54994208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00083199OtherRAILROAD MEDICARE
AL59169402OtherBCBS AL
FLK0876OtherMEDICARE GROUP NUMBER
FL09113OtherBCBS FL
FL45147OtherBC BS FL GROUP NUMBER
FL45147OtherBC BS FL GROUP NUMBER
FL258618500Medicaid