Provider Demographics
NPI:1104993005
Name:BLAS A REYES MD PA
Entity type:Organization
Organization Name:BLAS A REYES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-273-8337
Mailing Address - Street 1:8940 N KENDALL DRIVE
Mailing Address - Street 2:#1002 E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2178
Mailing Address - Country:US
Mailing Address - Phone:305-273-8337
Mailing Address - Fax:305-273-0144
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:1002 E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2178
Practice Address - Country:US
Practice Address - Phone:305-273-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08939Medicare ID - Type Unspecified
D08520Medicare UPIN