Provider Demographics
NPI:1336288356
Name:REY, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:REY
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 1:9931 OAK HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1041
Mailing Address - Country:US
Mailing Address - Phone:314-251-6382
Mailing Address - Fax:314-251-4454
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:J F K HEALTH CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-4283
Practice Address - Fax:314-251-7247
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9J16207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203261029Medicaid
MO2181OtherHEALTHCARE USA
MOE87704OtherMERCYCARE PLUS
MO203261029Medicaid
MO2181OtherHEALTHCARE USA
MO013013389Medicare ID - Type Unspecified