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1154361210

NPI Code Detail

MEDICARE: RANDY C. REYES MD

MEDICARE: RANDY C. REYES 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	J6691	TX
2	207P00000X	Emergency Medicine Physician	J6691	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154361210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY C. REYES MD

Provider Business Mailing Address
First Line	:	200 THE HILLS DR
Second Line	:
City	:	THE HILLS
State	:	TX
Zip	:	78738-1337
Country	:	US
Telephone Number	:	512-608-6703
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 E 32ND ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2703
Country	:	US
Telephone Number	:	512-476-7111
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/14/2010

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Directions to “ RANDY C. REYES MD” Practice Location

Language	Start Address	Practice Location

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