Provider Demographics
NPI:1528021664
Name:DY, JOHNNY REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:REYES
Last Name:DY
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 618
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0618
Mailing Address - Country:US
Mailing Address - Phone:828-572-0778
Mailing Address - Fax:828-726-3531
Practice Address - Street 1:639 PENNTON AVE SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5743
Practice Address - Country:US
Practice Address - Phone:828-572-0778
Practice Address - Fax:828-726-3531
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101545207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130HCOtherBCBS OF NC PROVIDER ID#
NC89130HCMedicaid
NC2296489Medicare PIN
NCF98549Medicare UPIN