Provider Demographics
NPI:1447589064
Name:HOMER C. REYES, M.D., PA
Entity Type:Organization
Organization Name:HOMER C. REYES, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-643-4255
Mailing Address - Street 1:14329 SAN PEDRO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4389
Mailing Address - Country:US
Mailing Address - Phone:210-494-2744
Mailing Address - Fax:210-494-2866
Practice Address - Street 1:7940 FLOYD CURL DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3907
Practice Address - Country:US
Practice Address - Phone:210-297-5520
Practice Address - Fax:210-297-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2962207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00198811OtherMEDICARE RAILROAD
TXP00198811OtherMEDICARE RAILROAD
TX0A5783Medicare PIN
TX0978900-1Medicaid