Provider Demographics
NPI:1700875143
Name:DEPAZ REYES, BERNARDO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:ANTONIO
Last Name:DEPAZ REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 270187
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-2987
Mailing Address - Country:US
Mailing Address - Phone:787-768-2335
Mailing Address - Fax:787-769-3308
Practice Address - Street 1:GP3 AVE CAMPO RICO
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2677
Practice Address - Country:US
Practice Address - Phone:787-768-2335
Practice Address - Fax:787-769-3308
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2931207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77169Medicare UPIN