Provider Demographics
NPI:1578584355
Name:REYES, JOSE R JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:REYES
Suffix:JR
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 5607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5607
Mailing Address - Country:US
Mailing Address - Phone:281-991-2200
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:5010 CRENSHAW RD
Practice Address - Street 2:STE. #130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9299207L00000X, 208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080656401Medicaid
TX115999804Medicaid
TX0004CGOtherMEDICARE PPMC GROUP #
TX0046CCOtherMEDICARE RPK GROUP #
TX115999802Medicaid
TX00747YOtherMEDICARE BEAUMONT GROUP #
TXP080560G5Medicaid
TX079696301Medicaid
TX0A3441OtherMEDICARE BPMC GROUP #
0A6286OtherMEDICARE PRINCIPLE GROUP #
TX115999803Medicaid
TX0A3441OtherMEDICARE BPMC GROUP #
G17204Medicare UPIN
TX00747YOtherMEDICARE BEAUMONT GROUP #
TX8E0573Medicare PIN
TX8F24546Medicare PIN