MEDICARE: SAMUEL A REYES MD PHD

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	390200000X	Student in an Organized Health Care Education/Training Program	TRN8181	FL
2	207Y00000X	Otolaryngology Physician	253206	NY

General Provider Information

NPI Number	:	1598976391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL A REYES MD PHD

Provider Business Mailing Address
First Line	:	180 PARK CLUB LN STE 200
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5258
Country	:	US
Telephone Number	:	786-325-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 PARK CLUB LN STE 200
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5258
Country	:	US
Telephone Number	:	786-325-0644
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	06/03/2009

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