Provider Demographics
NPI:1548245269
Name:REYNS, PHILIPPE Y (MD)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:Y
Last Name:REYNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD STE 311
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:480-830-5669
Mailing Address - Fax:480-830-8074
Practice Address - Street 1:201 W GUADALUPE RD STE 311
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-830-5669
Practice Address - Fax:480-830-8074
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ236283OtherMERCY CARE
AZ2297743OtherAETNA
AZ2Z0775OtherHEALTHNET
AZP00071493OtherRAILROAD MEDICARE
AZAZ0736430OtherBLUS CROSS OF AZ
AZ236283OtherAHCCCS
AZD00175Medicare UPIN
AZ2297743OtherAETNA