Provider Demographics
NPI:1598743668
Name:HERNANDEZ-REYES, JOSE GUADALUPE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:GUADALUPE
Last Name:HERNANDEZ-REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 INDIAN SCHOOL RD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3991
Mailing Address - Country:US
Mailing Address - Phone:505-727-4200
Mailing Address - Fax:
Practice Address - Street 1:3900 LAS ESTANCIAS CT SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5513
Practice Address - Country:US
Practice Address - Phone:505-727-4200
Practice Address - Fax:575-727-9590
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046971207R00000X
NM87-182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104761737Medicaid
MI11-0-H2-4201-0OtherBCBS
MI11-0-H2-4201-0OtherBCBS
MI104761737Medicaid