Provider Demographics
NPI:1457358087
Name:SARMIENTO, REYNALDO D (MD PA)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:D
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2388
Mailing Address - Country:US
Mailing Address - Phone:903-572-8741
Mailing Address - Fax:903-577-0640
Practice Address - Street 1:2001 N JEFFERSON AVE
Practice Address - Street 2:STE 120
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2388
Practice Address - Country:US
Practice Address - Phone:903-572-8741
Practice Address - Fax:903-577-0640
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3102208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115807301Medicaid
B26185Medicare UPIN
TX115807301Medicaid