Provider Demographics
NPI:1790742930
Name:REYES, RICARDO (DPM)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 SW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6974
Mailing Address - Country:US
Mailing Address - Phone:305-598-1039
Mailing Address - Fax:
Practice Address - Street 1:8351 SW 85TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-6974
Practice Address - Country:US
Practice Address - Phone:305-598-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390086000Medicaid
FL390086000Medicaid
FL65274Medicare ID - Type Unspecified