Provider Demographics
NPI:1952454274
Name:REYES, JOSE KEYSER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:KEYSER
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1625 TULLY RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2541
Mailing Address - Country:US
Mailing Address - Phone:408-929-0606
Mailing Address - Fax:408-929-1115
Practice Address - Street 1:1625 TULLY ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-929-0606
Practice Address - Fax:408-929-1115
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A533791Medicaid
G14561Medicare UPIN
CA00A533790Medicare ID - Type Unspecified