Provider Demographics
NPI:1487611158
Name:TOPETE, REYES R (MD)
Entity type:Individual
Prefix:
First Name:REYES
Middle Name:R
Last Name:TOPETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3145 E CHANDLER BLVD
Mailing Address - Street 2:STE 110 PMB 437
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:623-680-0096
Mailing Address - Fax:866-761-1196
Practice Address - Street 1:3145 E CHANDLER BLVD
Practice Address - Street 2:STE 110 PMB 437
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8702
Practice Address - Country:US
Practice Address - Phone:623-680-0096
Practice Address - Fax:866-761-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22381207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ335720Medicaid
AZF89904Medicare UPIN
AZZ142960Medicare PIN