Provider Demographics
NPI:1588877799
Name:REYES, ANTHONY L (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-636-3892
Mailing Address - Fax:360-414-1342
Practice Address - Street 1:300 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-2304
Practice Address - Country:US
Practice Address - Phone:360-353-5511
Practice Address - Fax:360-353-5502
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60329830207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025797Medicaid
WAG8918036Medicare PIN