Healthcare Provider Details

I. General information

NPI: 1053690479
Provider Name (Legal Business Name): JUAN CARLOS REY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 PEMBROKE RD STE 300
MIRAMAR FL
33027-2544
US

IV. Provider business mailing address

12600 PEMBROKE RD STE 300
MIRAMAR FL
33027-2544
US

V. Phone/Fax

Practice location:
  • Phone: 954-390-1895
  • Fax:
Mailing address:
  • Phone: 954-390-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME123294
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: