MEDICARE: DR. SUSAN REYES MD

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	MD42643	TN

General Provider Information

NPI Number	:	1902834203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN REYES MD

Provider Business Mailing Address
First Line	:	9901 SIERRA VISTA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-5736
Country	:	US
Telephone Number	:	865-599-0300
Fax Number	:	865-321-8887

Provider Business Practice Location Address
First Line	:	9901 SIERRA VISTA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-5736
Country	:	US
Telephone Number	:	865-599-0300
Fax Number	:	865-321-8887

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/25/2016

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