Provider Demographics
NPI:1720040041
Name:REYES, RICARDO R (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:R
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 1:5333 N DIXIE HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3454
Mailing Address - Country:US
Mailing Address - Phone:954-772-3544
Mailing Address - Fax:954-772-3545
Practice Address - Street 1:5333 N DIXIE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3454
Practice Address - Country:US
Practice Address - Phone:954-772-3544
Practice Address - Fax:954-772-3545
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054512207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049011301Medicaid
FLE61604Medicare UPIN
FL07811WMedicare ID - Type Unspecified
FL049011301Medicaid