MEDICARE: DR. ROBERTO REYES RODRIGUEZ 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	174400000X	Specialist	10318	PR

General Provider Information

NPI Number	:	1164428132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO REYES RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1869
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-1869
Country	:	US
Telephone Number	:	787-825-2966
Fax Number	:	787-825-6177

Provider Business Practice Location Address
First Line	:	19 CALLE BALDORIOTY
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2412
Country	:	US
Telephone Number	:	787-825-2966
Fax Number	:	787-825-6177

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/08/2007

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