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General NPI Number Information
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NPI Number | 1104810399
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Entity Type | Individual
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Provider Name | LEOVIGILDO J REYES M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 4401 N ANDREWS AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33309-3917
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Country | US
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Telephone | 954-900-4686
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Fax | 954-900-2655
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Provider Business Mailing Address
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Address Line | 4401 N ANDREWS AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33309-3917
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Country | US
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Telephone | 954-900-4686
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Fax | 954-900-2655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 038929
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME85999
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 038929
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME85999
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME85999
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License Number State | FL
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