Provider Demographics
NPI:1891961058
Name:REYNALDO D SARMIENTO MD PA
Entity Type:Organization
Organization Name:REYNALDO D SARMIENTO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:SARMIENTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-572-8741
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:ST 120
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2386
Mailing Address - Country:US
Mailing Address - Phone:903-572-8741
Mailing Address - Fax:903-577-0640
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:ST 120
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2386
Practice Address - Country:US
Practice Address - Phone:903-572-8741
Practice Address - Fax:903-577-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3102208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115807301Medicaid
TX00R187Medicare PIN
TXB26185Medicare UPIN