Provider Demographics
NPI:1982620480
Name:REYES, CESAR AUGUSTO (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:AUGUSTO
Last Name:REYES
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:
Practice Address - Street 1:1700 N LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7600
Practice Address - Country:US
Practice Address - Phone:214-733-8001
Practice Address - Fax:972-542-3559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2458207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179215201Medicaid
TX179213701Medicaid
TX8F1517Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX00707ZMedicare ID - Type UnspecifiedGROUP NUMBER
TX179215201Medicaid