Provider Demographics
NPI:1427040427
Name:REYES, MATEO (MD)
Entity Type:Individual
Prefix:
First Name:MATEO
Middle Name:
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:PO BOX 451490
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0036
Mailing Address - Country:US
Mailing Address - Phone:956-722-5007
Mailing Address - Fax:956-725-5894
Practice Address - Street 1:3527 JAIME ZAPATA MEMORIAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4788
Practice Address - Country:US
Practice Address - Phone:956-722-5007
Practice Address - Fax:956-725-5894
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127104103Medicaid
TX127104106Medicaid
TX00728LOtherMEDICARE NUMBER
TX127104106Medicaid