MEDICARE: LUIS A REYNOSO MD

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	207R00000X	Internal Medicine Physician	K1637	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063402741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS A REYNOSO MD

Provider Business Mailing Address
First Line	:	2401 N ED CAREY DR
Second Line	:	STE C
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8205
Country	:	US
Telephone Number	:	956-425-7800
Fax Number	:	956-425-7801

Provider Business Practice Location Address
First Line	:	2401 N ED CAREY DR
Second Line	:	STE C
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8205
Country	:	US
Telephone Number	:	956-425-7800
Fax Number	:	956-425-7801

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	01/28/2016

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