Provider Demographics
NPI:1194889816
Name:ANTONIO J REYES MD PA
Entity type:Organization
Organization Name:ANTONIO J REYES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-267-2182
Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-267-2182
Mailing Address - Fax:305-267-1244
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-267-2182
Practice Address - Fax:305-267-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26540Medicare PIN
FLF96880Medicare UPIN