Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD475149 | PA |
NPI | 1013303387 |
---|---|
Provider Name | Ronald Reyes |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18702-7906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 05/10/2021 |