Provider Demographics
NPI:1437141546
Name:REYNA, GEORGE S (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:REYNA
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 1:215 E QUINCY ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2034
Mailing Address - Country:US
Mailing Address - Phone:210-222-9172
Mailing Address - Fax:210-222-0996
Practice Address - Street 1:215 E QUINCY ST
Practice Address - Street 2:SUITE 505
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2034
Practice Address - Country:US
Practice Address - Phone:210-222-9172
Practice Address - Fax:210-222-0996
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5796207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0061CJOtherBLUECROSS
TX113217703Medicaid
180034481OtherMEDICARE RAILROAD
TX113217703Medicaid
TX00021JMedicare PIN