Provider Demographics
NPI:1508055989
Name:FLORENCIO L REYES MD INC
Entity Type:Organization
Organization Name:FLORENCIO L REYES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-492-3245
Mailing Address - Street 1:430 4TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1100
Mailing Address - Country:US
Mailing Address - Phone:937-492-3245
Mailing Address - Fax:937-492-0795
Practice Address - Street 1:430 4TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1100
Practice Address - Country:US
Practice Address - Phone:937-492-3245
Practice Address - Fax:937-492-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9287111Medicare PIN