Provider Demographics
NPI:1043288715
Name:DE LOS REYES, BAYANI BELEN (MD)
Entity type:Individual
Prefix:DR
First Name:BAYANI
Middle Name:BELEN
Last Name:DE LOS 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 1:1167 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6317
Mailing Address - Country:US
Mailing Address - Phone:740-382-8200
Mailing Address - Fax:740-389-6241
Practice Address - Street 1:1167 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6317
Practice Address - Country:US
Practice Address - Phone:740-382-8200
Practice Address - Fax:740-389-6241
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045847207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0452899Medicaid
OH0452899Medicaid
0491463Medicare PIN
A79915Medicare UPIN