Provider Demographics
NPI:1679681258
Name:REYES, PATRICIO F (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:F
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-254-7904
Practice Address - Street 1:401 PHALEN BLVD - MS 41104C
Practice Address - Street 2:HEALTHPARTNERS SPECIALTY CENTER 401
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7900
Practice Address - Fax:651-254-7904
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
AZ335422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ898174Medicaid
AZ100400Medicare ID - Type UnspecifiedMEDICARE #
AZ898174Medicaid