MEDICARE: DR. BRYAN ANTHONY REYES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	DR.0062268	CO
2	207X00000X	Orthopaedic Surgery Physician	Q0349	TX
3	207XS0106X	Orthopaedic Hand Surgery Physician	DR.0062268	CO
4	207XS0106X	Orthopaedic Hand Surgery Physician	Q0349	TX

General Provider Information

NPI Number	:	1023308384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN ANTHONY REYES M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 W TERRELL AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3100
Country	:	US
Telephone Number	:	817-877-3277
Fax Number	:	817-877-3280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	08/13/2019

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