Healthcare Provider Details

I. General information

NPI: 1205829074
Provider Name (Legal Business Name): ANDRES M REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 213
ALTAMONTE SPRINGS FL
32701-5102
US

IV. Provider business mailing address

661 E ALTAMONTE DR STE 213
ALTAMONTE SPRINGS FL
32701-5102
US

V. Phone/Fax

Practice location:
  • Phone: 407-951-5883
  • Fax: 407-951-8326
Mailing address:
  • Phone: 407-951-5883
  • Fax: 407-951-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME100755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: