Provider Demographics
NPI:1427035427
Name:REYES, ROLAND J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:J
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1997 HEALTHWAY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2834
Mailing Address - Country:US
Mailing Address - Phone:440-988-6880
Mailing Address - Fax:440-988-6869
Practice Address - Street 1:1997 HEALTHWAY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2834
Practice Address - Country:US
Practice Address - Phone:440-988-6880
Practice Address - Fax:440-988-6869
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-061473208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0999737Medicaid
0765473Medicare PIN
OH0999737Medicaid