Provider Demographics
NPI:1962766642
Name:REYES ORTIZ, CARLOS ALFONSO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALFONSO
Last Name:REYES ORTIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7675 PHOENIX DR
Mailing Address - Street 2:APT 715
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4700
Mailing Address - Country:US
Mailing Address - Phone:409-256-0290
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:MSB 5.111
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6295
Practice Address - Fax:713-500-0706
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2016-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA71399207RG0300X
TX44958207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine