MEDICARE: LEOVIGILDO REYES MD PA

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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1184307456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEOVIGILDO REYES MD PA

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	:	MANAGER
Name	:	RICARDO J. SIMMONS
Credential	:	RN
Telephone Number	:	954-900-4686

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	03/15/2024

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