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General NPI Number Information
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NPI Number | 1174584809
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Entity Type | Individual
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Provider Name | ANTONIO REYES MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 600 N HIATUS RD SUITE 209
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5207
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Country | US
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Telephone | 954-965-9860
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Fax | 954-965-9870
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Provider Business Mailing Address
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Address Line | 2160 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
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City | FORT MYERS
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State | FL
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Zip | 33907-1410
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME70206
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License Number State | FL
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