Provider Demographics
NPI:1942485842
Name:REYES, MARCOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
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 1:617 E RIVERSIDE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8720
Mailing Address - Country:US
Mailing Address - Phone:435-628-4507
Mailing Address - Fax:
Practice Address - Street 1:617 E RIVERSIDE DR
Practice Address - Street 2:STE 101
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8720
Practice Address - Country:US
Practice Address - Phone:435-628-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16046207W00000X
UT9454371-8905207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360295Medicare PIN