MEDICARE: DR. LEOVIGILDO J 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	208D00000X	General Practice Physician	038929	GA
2	208VP0000X	Pain Medicine Physician	ME85999	FL
3	208VP0014X	Interventional Pain Medicine Physician	038929	GA
4	208D00000X	General Practice Physician	ME85999	FL
5	208VP0014X	Interventional Pain Medicine Physician	ME85999	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038929	OTHER	GA	AMERIGROUP
2	ME85999	OTHER	FL	AETNA
3	038929	OTHER	GA	WELLCARE
4	038929	OTHER	GA	CARE SOURCE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	038929	OTHER	GA	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	038929	OTHER	GA	PEACH STATE
9	ME85999	OTHER	FL	WELLCARE
10	ME85999	OTHER	FL	AMBETTER
11	038929	OTHER	GA	AMBETTER

General Provider Information

NPI Number	:	1104810399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEOVIGILDO J REYES M.D.

Provider Business Mailing Address
First Line	:	4401 N ANDREWS AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3917
Country	:	US
Telephone Number	:	954-900-4686
Fax Number	:	954-900-2655

Provider Business Practice Location Address
First Line	:	4401 N ANDREWS AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3917
Country	:	US
Telephone Number	:	954-900-4686
Fax Number	:	954-900-2655

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	03/15/2024

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