Provider Demographics
NPI:1336147842
Name:REYES, EFRAIN BERRIOS (MD)
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:BERRIOS
Last Name:REYES
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 7000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-8829
Mailing Address - Fax:225-765-8283
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 7000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-8829
Practice Address - Fax:225-765-8283
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110160568OtherRAILROAD MEDICARE
LA1326836Medicaid
LA1326836Medicaid
LAB89100Medicare UPIN
LAB89100Medicare UPIN