Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 9962 | PR |
N | 207XS0117X | Orthopaedic Spine Surgeon | 9962 | PR |
NPI | 1396820270 |
---|---|
Provider Name | Pedro J Reyes - Martinez |
First Address | Barceloneta, PR 00617-0719 |
Second Address | Rio Piedras, PR 00935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 15/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8-2111RE | SSS (01) | PR |
E08307 | (02) | PR |