MEDICARE: DR. ANTONIO P REYES 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	207V00000X	Obstetrics & Gynecology Physician	F2876	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	751652471	OTHER	TX	FEDERAL TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00FA63	OTHER	TX	BLUE CROSS OF TEXAS

General Provider Information

NPI Number	:	1740297993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO P REYES M.D.

Provider Business Mailing Address
First Line	:	2005 N JEFFERSON AVE
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2336
Country	:	US
Telephone Number	:	903-572-4381
Fax Number	:	903-572-9575

Provider Business Practice Location Address
First Line	:	2005 N JEFFERSON AVE
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2336
Country	:	US
Telephone Number	:	903-572-4381
Fax Number	:	903-572-9575

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ANTONIO P REYES M.D.” Practice Location

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