Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 11652 | OK |
NPI | 1497770911 |
---|---|
Provider Name | Dr. Santiago Reyes |
First Address | Oklahoma City, OK 73112-4462 |
Second Address | Oklahoma City, OK 73112-4462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 02/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E51951 | (02) | OK |