Provider Demographics
NPI:1679687735
Name:REYNO, JORGE RAMIRO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:RAMIRO
Last Name:REYNO
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:PO BOX 2652
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2652
Mailing Address - Country:US
Mailing Address - Phone:605-737-7777
Mailing Address - Fax:
Practice Address - Street 1:550 N 5TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1375
Practice Address - Country:US
Practice Address - Phone:605-737-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4786207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6003872Medicaid
SDS100599Medicare PIN
SD6003872Medicaid