Provider Demographics
NPI:1720243298
Name:REYES, LOUIS C (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:C
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 1:2054 WIRT RD STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2474
Mailing Address - Country:US
Mailing Address - Phone:713-551-1785
Mailing Address - Fax:713-263-7244
Practice Address - Street 1:2054 WIRT RD STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-2474
Practice Address - Country:US
Practice Address - Phone:713-551-1785
Practice Address - Fax:713-263-7244
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3589208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21008Medicare UPIN