Provider Demographics
NPI:1952321978
Name:REYES, ANTONIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:J
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-267-2182
Mailing Address - Fax:305-267-1244
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-267-2182
Practice Address - Fax:305-267-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0065030208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650766743OtherTAX ID#
FLF96880Medicare UPIN
FL26540Medicare PIN