Provider Demographics
NPI:1316126964
Name:JONATHAN DELOS REYES, M.D.
Entity type:Organization
Organization Name:JONATHAN DELOS REYES, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGTENHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-565-0600
Mailing Address - Street 1:4308 MESA DR STE A
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3459
Mailing Address - Country:US
Mailing Address - Phone:940-565-0600
Mailing Address - Fax:940-565-1538
Practice Address - Street 1:4308 MESA DR STE A
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3459
Practice Address - Country:US
Practice Address - Phone:940-565-0600
Practice Address - Fax:940-565-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00933VMedicare PIN