Provider Demographics
NPI:1295782803
Name:DE LOS REYES, RAUL ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ALBERTO
Last Name:DE LOS REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:ASCHER BLDG, 2ND FL
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-674-3977
Mailing Address - Fax:305-535-7919
Practice Address - Street 1:4302 ALTON ROAD
Practice Address - Street 2:MSOP SUITE 830
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140
Practice Address - Country:US
Practice Address - Phone:305-674-2404
Practice Address - Fax:305-674-2544
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2010-02-05
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Provider Licenses
StateLicense IDTaxonomies
FLME94492207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64811Medicare UPIN
U6852ZMedicare ID - Type Unspecified