Basic Information
| Provider Information | |||||||||
| NPI: | 1336408830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | MISHANTA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 LOWELL DR SE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562654462 | ||||||||
| FaxNumber: | 2294364107 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 7TH ST SE FL 2 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569735216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2012 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 1800 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.