Healthcare Provider Details

I. General information

NPI: 1689636631
Provider Name (Legal Business Name): PAUL REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N RIDGE ROAD LONE STAR PEDIATRICS
MCKINNEY TX
75071-6962
US

IV. Provider business mailing address

177 RIDGE ROAD
MCKINNEY TX
75071
US

V. Phone/Fax

Practice location:
  • Phone: 469-591-1900
  • Fax: 866-695-1347
Mailing address:
  • Phone: 469-388-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL9870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: