Provider Demographics
NPI:1760644975
Name:REYES-PESCADOR, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:REYES-PESCADOR
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 1:1000 ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8288
Mailing Address - Country:US
Mailing Address - Phone:214-563-6319
Mailing Address - Fax:972-685-5185
Practice Address - Street 1:10325 LAKE JUNE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-5312
Practice Address - Country:US
Practice Address - Phone:972-677-7331
Practice Address - Fax:972-685-5185
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4693208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery