Provider Demographics
NPI:1740297993
Name:REYES, ANTONIO P (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:P
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2336
Mailing Address - Country:US
Mailing Address - Phone:903-572-4381
Mailing Address - Fax:903-572-9575
Practice Address - Street 1:2005 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2336
Practice Address - Country:US
Practice Address - Phone:903-572-4381
Practice Address - Fax:903-572-9575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2876207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751652471OtherFEDERAL TAX ID
TX128148702Medicaid
TX00FA63OtherBLUE CROSS OF TEXAS
TX751652471OtherFEDERAL TAX ID
TX00FA63Medicare ID - Type Unspecified