Provider Demographics
NPI:1952735672
Name:JAVIER G. REYES MDPA
Entity Type:Organization
Organization Name:JAVIER G. REYES MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLADOVNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-222-9131
Mailing Address - Street 1:811 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1107
Mailing Address - Country:US
Mailing Address - Phone:210-222-9131
Mailing Address - Fax:210-229-1148
Practice Address - Street 1:811 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1107
Practice Address - Country:US
Practice Address - Phone:210-222-9131
Practice Address - Fax:210-229-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8844207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032466701Medicaid
TX00CE60Medicare PIN
TX032466701Medicaid