Provider Demographics
NPI:1417923707
Name:REYES, JOSE ISMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ISMAEL
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 1:4400 N SCOTTSDALE RD STE 9-252
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3331
Mailing Address - Country:US
Mailing Address - Phone:623-308-2472
Mailing Address - Fax:623-218-9061
Practice Address - Street 1:6350 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2857
Practice Address - Country:US
Practice Address - Phone:480-345-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ425932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101847625Medicaid
AZ558601Medicaid
AZ558601Medicaid
PA110204Medicare PIN