MEDICARE: MR. JOSE 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	207V00000X	Obstetrics & Gynecology Physician	031786	CT

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	:	1104823897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE REYES M.D.

Provider Business Mailing Address
First Line	:	309 STILLSON RD
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3213
Country	:	US
Telephone Number	:	203-366-8700
Fax Number	:	203-367-8080

Provider Business Practice Location Address
First Line	:	309 STILLSON RD
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3213
Country	:	US
Telephone Number	:	203-366-8700
Fax Number	:	203-367-8080

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/18/2013

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Directions to “ MR. JOSE REYES M.D.” Practice Location

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