Provider Demographics
NPI:1457350571
Name:REYES, ELMORE AKYATIN (MD)
Entity Type:Individual
Prefix:
First Name:ELMORE
Middle Name:AKYATIN
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 1:1625 SE 3RD AVE
Mailing Address - Street 2:STE 601
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-462-4413
Mailing Address - Fax:954-462-5413
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:STE 601
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-462-4413
Practice Address - Fax:954-462-5413
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41066207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD78848Medicare UPIN
FL94075Medicare ID - Type Unspecified