Individual
DR. REAGAN MICHELLE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 12TH AVE, SUITE 200, FORT WORTH, TX 76104-3926
(817) 850-2000
(817) 850-2015
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
N-3333
TX
207VX0201X
Gynecologic Oncology Physician
Primary
N3333
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204651802
—
TX
01
—
2766284705
MYUTMB 2766284705
—
Enumeration date
08/05/2007
Last updated
10/03/2012
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