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General NPI Number Information
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NPI Number | 1528021664
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Entity Type | Individual
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Provider Name | JOHNNY REYES DY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 639 PENNTON AVE SW
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City | LENOIR
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State | NC
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Zip | 28645-5743
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Country | US
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Telephone | 828-572-0778
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Fax | 828-726-3531
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Provider Business Mailing Address
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Address Line | PO BOX 618
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City | LENOIR
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State | NC
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Zip | 28645-0618
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Country | US
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Telephone | 828-572-0778
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Fax | 828-726-3531
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 200101545
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License Number State | NC
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