Provider Demographics
NPI:1881837128
Name:REYES, CIRILA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CIRILA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S MAIN STREET
Mailing Address - Street 2:POPLARVILLE FAMILY MEDICAL CLINIC
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470
Mailing Address - Country:US
Mailing Address - Phone:601-795-9320
Mailing Address - Fax:601-795-9876
Practice Address - Street 1:1222 S MAIN STREET
Practice Address - Street 2:POPLARVILLE FAMILY MEDICAL CLINIC
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470
Practice Address - Country:US
Practice Address - Phone:601-795-9320
Practice Address - Fax:601-795-9876
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS09382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0019965Medicaid
MS0019965Medicaid