Provider Demographics
NPI:1780633255
Name:DELOS REYES, JONATHAN CONSTANTINO (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CONSTANTINO
Last Name:DELOS REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4308 MESA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3459
Mailing Address - Country:US
Mailing Address - Phone:940-565-0600
Mailing Address - Fax:940-565-1538
Practice Address - Street 1:4308 MESA DR
Practice Address - Street 2:SUITE A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3459
Practice Address - Country:US
Practice Address - Phone:940-565-0600
Practice Address - Fax:940-565-1538
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8112207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G16091Medicare UPIN
TX00933VMedicare PIN
TX8B2762Medicare ID - Type Unspecified