Provider Demographics
NPI:1508983792
Name:MICHELLE R. REYNA, M.D., P.A.
Entity Type:Organization
Organization Name:MICHELLE R. REYNA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-946-2341
Mailing Address - Street 1:1411 N. BECKLEY AVE
Mailing Address - Street 2:PAV III, STE 356
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-941-6228
Mailing Address - Fax:214-941-6079
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAV III, STE 356
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-941-6228
Practice Address - Fax:214-941-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190039101Medicaid
TX0020PMOtherB/C B/S
TX0020PMOtherB/C B/S