Provider Demographics
NPI:1992909329
Name:REYES, CARLOS EFRAIN (MD, MS)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EFRAIN
Last Name:REYES
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:EFRAIN
Other - Last Name:REYES-PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:2230 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1391
Mailing Address - Country:US
Mailing Address - Phone:352-237-4133
Mailing Address - Fax:352-237-7728
Practice Address - Street 1:2230 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1391
Practice Address - Country:US
Practice Address - Phone:352-237-4133
Practice Address - Fax:352-237-7728
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18287207R00000X, 208D00000X
FLME123955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHR178AMedicare Oscar/Certification