Provider Demographics
NPI:1639127525
Name:REYES-AYALA, EDGARDO R (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:R
Last Name:REYES-AYALA
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 1:5000 UNIVERSITY DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2008
Mailing Address - Country:US
Mailing Address - Phone:305-663-0088
Mailing Address - Fax:305-663-1933
Practice Address - Street 1:5000 UNIVERSITY DR STE 1100
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2008
Practice Address - Country:US
Practice Address - Phone:305-663-0088
Practice Address - Fax:305-663-1933
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74498207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254669800Medicaid
FL42866ZMedicare PIN
FLG82565Medicare UPIN