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Individual
REGAN REA
Active
Individual
REGAN REA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00721
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067463008
REGENCE
OR
05
—
500604207
—
OR
01
—
911019392
COMMERCIAL
—
01
—
M0665 17
PACIFIC SOURCE
—
Enumeration date
10/12/2006
Last updated
11/08/2012
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