Individual
BRENDAN W REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE, SUITE 500, FORT WORTH, TX 76104-2820
(817) 252-5000
Mailing address
1300 W TERRELL AVE, SUITE 500, FORT WORTH, TX 76104-2820
(817) 252-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
42929
TN
207RC0000X
Cardiovascular Disease Physician
P2158
TX
207RI0011X
Interventional Cardiology Physician
Primary
P2158
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009880173
AETNA
—
05
—
1506020
—
TN
05
—
305771301
—
TX
01
—
4190818
BCBST
TN
01
—
7100051780
KENTUCKY MEDICAID
KY
Enumeration date
01/04/2007
Last updated
08/18/2014
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