Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME136295 | FL |
NPI | 1043484678 |
---|---|
Provider Name | Karl Reyes |
First Address | Clearwater, FL 33759-3012 |
Second Address | Tampa, FL 33607-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/06/2021 |