Provider Demographics
NPI:1396820270
Name:REYES - MARTINEZ, PEDRO J (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:REYES - MARTINEZ
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:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0719
Mailing Address - Country:US
Mailing Address - Phone:787-764-5095
Mailing Address - Fax:787-620-0714
Practice Address - Street 1:ORTOPEDIA RCM - ESCUELA DE MEDICINA
Practice Address - Street 2:CENTRO MEDICO DE PUERTO RICO, BO MONACILLOS
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-764-5095
Practice Address - Fax:787-620-0714
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9962207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-2111REOtherSSS
PRE08307Medicare UPIN