Provider Demographics
NPI:1619990314
Name:REYES, JAIME MAGBUAL (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MAGBUAL
Last Name:REYES
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 1:1713 SW HEALTH PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0502
Mailing Address - Country:US
Mailing Address - Phone:239-597-8000
Mailing Address - Fax:
Practice Address - Street 1:1713 SW HEALTH PKWY STE 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0502
Practice Address - Country:US
Practice Address - Phone:239-597-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28655208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11720OtherBLUE CROSS OF FLORIDA
FL052132900Medicaid
FL11720OtherBLUE CROSS OF FLORIDA
FLE34690Medicare UPIN
FL052132900Medicaid