Individual
TERRENCE REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4005 HIGH RESORT BLVD SE, PMG HIGH RESORT 4005, RIO RANCHO, NM 87124-5906
(505) 462-6000
(505) 462-8472
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
92124
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E4894
—
NM
Enumeration date
10/03/2006
Last updated
03/24/2016
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