Provider Demographics
NPI:1053519322
Name:REYES, JOSE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78293-0806
Mailing Address - Country:US
Mailing Address - Phone:210-877-0772
Mailing Address - Fax:210-877-0785
Practice Address - Street 1:12730 W IH 10
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1003
Practice Address - Country:US
Practice Address - Phone:210-877-0772
Practice Address - Fax:210-877-0785
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6540207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140228133Medicaid
TXE56713Medicare UPIN
TX140228133Medicaid