Provider Demographics
NPI:1912015660
Name:REYES, HOMER CALVIN (MD)
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:CALVIN
Last Name:REYES
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 1:14329 SAN PEDRO AVE
Mailing Address - Street 2:STE C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4389
Mailing Address - Country:US
Mailing Address - Phone:210-494-2744
Mailing Address - Fax:210-494-2866
Practice Address - Street 1:7930 FLOYD CURL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3925
Practice Address - Country:US
Practice Address - Phone:210-297-5520
Practice Address - Fax:210-297-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2962174400000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00198811OtherMEDICARE RAILROAD
TX00D64GOtherBLUE CROSS BLUE SHIELD
TX097890001Medicaid
TX00D64GOtherBLUE CROSS BLUE SHIELD
E16409Medicare UPIN