Provider Demographics
NPI:1649365883
Name:EDGARDO R. REYES-AYALA, M.D. P.A.
Entity type:Organization
Organization Name:EDGARDO R. REYES-AYALA, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES-AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-0088
Mailing Address - Street 1:5000 UNIVERSITY DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2008
Mailing Address - Country:US
Mailing Address - Phone:305-663-0088
Mailing Address - Fax:305-663-1933
Practice Address - Street 1:5000 UNIVERSITY DR STE 1100
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2008
Practice Address - Country:US
Practice Address - Phone:305-663-0088
Practice Address - Fax:305-663-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74498207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254669800Medicaid
FLG82565Medicare UPIN
FL254669800Medicaid