Provider Demographics
NPI:1356671184
Name:REYES, JOSEPHINE GOZUM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:GOZUM
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:907 SERO ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6082
Mailing Address - Country:US
Mailing Address - Phone:301-292-4058
Mailing Address - Fax:301-749-7112
Practice Address - Street 1:2700 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2601
Practice Address - Country:US
Practice Address - Phone:202-645-4874
Practice Address - Fax:202-563-5945
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD13943208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice