MEDICARE: ERIC W REYES GRAJALES 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	207R00000X	Internal Medicine Physician	261370	MA
2	207RI0200X	Infectious Disease Physician	261370	MA
3	207RI0200X	Infectious Disease Physician	ME126359	FL
4	207R00000X	Internal Medicine Physician	ME126359	FL

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

General Provider Information

NPI Number	:	1649404013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC W REYES GRAJALES M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9680
Fax Number	:	239-343-9685

Provider Business Practice Location Address
First Line	:	2780 CLEVELAND AVE
Second Line	:	SUITE 809
City	:	FORT MYERS
State	:	FL
Zip	:	33901-5817
Country	:	US
Telephone Number	:	239-343-9680
Fax Number	:	239-343-9685

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

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	09/14/2021

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