Provider Demographics
NPI:1376514851
Name:REYES, RAUL SR (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:REYES
Suffix:SR
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:PO BOX 8307
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-743-4422
Mailing Address - Fax:787-743-4422
Practice Address - Street 1:BORGONA 3B53
Practice Address - Street 2:SECCION VILLA DEL REY
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-398-6837
Practice Address - Fax:787-743-4422
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11209208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083466Medicare ID - Type Unspecified
G40932Medicare UPIN