Provider Demographics
NPI:1174584809
Name:REYES, ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:600 N HIATUS RD
Practice Address - Street 2:SUITE 209
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5207
Practice Address - Country:US
Practice Address - Phone:954-965-9860
Practice Address - Fax:954-965-9870
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-04-12
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Provider Licenses
StateLicense IDTaxonomies
FLME70206208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2227616OtherAETNA
FL59436OtherHEALTH SUN
FLP01709685OtherSIMPLY HEALTHCARE
FL237204OtherAVMED
FLPRV0002461OtherPREFERRED MEDICAL PLAN
FL033303OtherNHP
FL8837OtherDIMENSION HEALTH
FL46607OtherBLUE CROSS BLUE SHIELD
FL5699441OtherAETNA
FLP01041697OtherRAILROAD MCR
FL24164OtherMEDICA
FLP942521OtherOPTIMUM
FLP1001893OtherFREEDOM HEALTH
FLQMP000003674076OtherMOLINA
FL256864100Medicaid
FLF00201863802OtherUNITED HEALTHCARE
FL033303OtherNHP
FL2227616OtherAETNA
FL256864100Medicaid