Provider Demographics
NPI:1245344977
Name:REY, ROBERTO MAURO (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:MAURO
Last Name:REY
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 1:640 S EXPY 77 STE 2
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-4241
Mailing Address - Country:US
Mailing Address - Phone:956-689-4120
Mailing Address - Fax:956-689-4142
Practice Address - Street 1:640 S EXPRESSWAY 77 STE 2
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4241
Practice Address - Country:US
Practice Address - Phone:956-689-4120
Practice Address - Fax:956-689-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5648186OtherFIRST HEALTH
TX039069202Medicaid
TX120589101OtherVALLEY HEALTH PLANS
TX8S4930OtherBC/BS OF TEXAS
TX039069203Medicaid
TX119773OtherSUPERIOR HEALTH PLANS
TX8170K1Medicare ID - Type Unspecified
TX039069202Medicaid