Individual
MICHAEL J REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
817 E 6TH ST, TISHOMINGO, OK 73460-1800
(580) 371-2392
Mailing address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 273-9911
(918) 273-9946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1474
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100768880F
—
OK
05
—
100768880I
—
OK
05
—
100768880J
—
OK
01
—
37-1803
MEDICARE
OK
01
—
37-1832
MEDICARE
OK
01
—
37-1834
MEDICARE
OK
Enumeration date
11/23/2005
Last updated
07/21/2022
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