Healthcare Provider Details

I. General information

NPI: 1417949629
Provider Name (Legal Business Name): ALAN B REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 N. FRESNO STREET SUITE 104
FRESNO CA
93710-5236
US

IV. Provider business mailing address

6327 N. FRESNO STREET SUITE 104
FRESNO CA
93710-5236
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-4020
  • Fax: 559-431-4589
Mailing address:
  • Phone: 559-431-4020
  • Fax: 559-431-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA52897
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA52897
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA52897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: