Provider Demographics
NPI:1942560594
Name:REYES, RAUL JR (MD,)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:REYES
Suffix:JR
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 1:2101 PEASE ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8307
Mailing Address - Country:US
Mailing Address - Phone:956-389-6565
Mailing Address - Fax:956-389-6567
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-389-6565
Practice Address - Fax:956-389-6567
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5917207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0458762-04Medicaid
TX0458762-04Medicaid