Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | L7132 | TX |
NPI | 1053363366 |
---|---|
Provider Name | Mr. Michael S. Reardon |
First Address | Austin, TX 78757-7589 |
Second Address | Austin, TX 78757-7589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H83688 | (02) | TX |