Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R5190 | TX |
N | 207NS0135X | Procedural Dermatology | R5190 | TX |
NPI | 1407260151 |
---|---|
Provider Name | Heather Reagin |
First Address | Austin, TX 78730-2309 |
Second Address | Saginaw, TX 76131-3575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 26/08/2021 |