MEDICARE: DR. TOBIAS RADHAMES REYES-TINEO 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	208600000X	Surgery Physician	4761	PR

General Provider Information

NPI Number	:	1629242540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOBIAS RADHAMES REYES-TINEO M.D.

Provider Business Mailing Address
First Line	:	CALLE 10 C 36 PASEO MAYOR
Second Line	:	URB. LOS PASEOS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4670
Country	:	US
Telephone Number	:	787-761-7720
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE 10 C 36 PASEO MAYOR
Second Line	:	URB. LOS PASEOS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4670
Country	:	US
Telephone Number	:	787-761-7720
Fax Number	:

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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