Provider Demographics
NPI:1689636631
Name:REYES, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
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 1:177 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:469-388-3755
Mailing Address - Fax:
Practice Address - Street 1:177 N RIDGE ROAD
Practice Address - Street 2:LONE STAR PEDIATRICS
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6962
Practice Address - Country:US
Practice Address - Phone:469-591-1900
Practice Address - Fax:866-695-1347
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI20815Medicare UPIN