Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | H-1191 | TX |
NPI | 1013185834 |
---|---|
Provider Name | David Reagan |
First Address | Waxahachie, TX 75165-5124 |
Second Address | Waxahachie, TX 75165-5124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 06/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131197907 | (05) | TX |
131197908 | (05) | TX |
153706003 | (05) | TX |
153706004 | (05) | TX |
8G6410 | BCBS (01) | TX |