1245344977 NPI number — DR. ROBERTO MAURO REY M.D.

Table of content: ROBERT P VALENTIN (NPI 1598254948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245344977 NPI number — DR. ROBERTO MAURO REY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REY
Provider First Name:
ROBERTO
Provider Middle Name:
MAURO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245344977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 S EXPY 77 STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYMONDVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78580-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-689-4120
Provider Business Mailing Address Fax Number:
956-689-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 S EXPRESSWAY 77 STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYMONDVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78580-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-689-4120
Provider Business Practice Location Address Fax Number:
956-689-4142
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L0540 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5648186 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 039069202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120589101 . This is a "VALLEY HEALTH PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8S4930 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 039069203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119773 . This is a "SUPERIOR HEALTH PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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