Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 47672 | AZ |
N | 111NI0900X | Internist | 47672 | AZ |
N | 207RC0200X | Critical Care Medicine | 47672 | AZ |
Y | 207RP1001X | Pulmonary Disease | 47672 | AZ |
NPI | 1083879357 |
---|---|
Provider Name | Nathaniel A. Reyes |
First Address | Phoenix, AZ 85038-9072 |
Second Address | Tucson, AZ 85712-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042339 | (05) | AZ |