Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 059179 | GA |
NPI | 1194767954 |
---|---|
Provider Name | Gerardo Reyes |
First Address | Atlanta, GA 31193-1968 |
Second Address | Savannah, GA 31403-3089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90529 | (02) | IL |
G59179 | (05) | SC |