Provider Demographics
NPI:1740297712
Name:REYNA, JOSE R JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:REYNA
Suffix:JR
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 1:500 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3639
Mailing Address - Country:US
Mailing Address - Phone:469-496-5200
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD STE 145
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5421
Practice Address - Country:US
Practice Address - Phone:972-440-1590
Practice Address - Fax:469-414-3472
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-88207X00000X, 207XS0117X
TXK8454207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1048Medicaid
NME1048Medicaid