Individual
MIRABELLE REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
639 N MULBERRY ST, ELIZABETHTOWN, KY 42701-1931
(270) 737-4600
(270) 737-1722
Mailing address
639 N MULBERRY ST, ELIZABETHTOWN, KY 42701-1931
(270) 737-4600
(270) 737-1722
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
02887
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64101090
—
KY
Enumeration date
06/16/2005
Last updated
06/29/2011
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