Individual
PATRICK RAY REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6550 FANNIN ST STE 2435, HOUSTON, TX 77030
(713) 790-3140
Mailing address
6550 FANNIN ST STE 2435, HOUSTON, TX 77030-2767
(713) 790-3140
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G5518
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134231308
—
TX
05
—
134231309
—
TX
01
—
8AC476
BLUE CROSS BLUE SHIELD
TX
01
—
8DY834
BLUE CROSS BLUE SHIELD
TX
01
—
8G5880
BCBS
TX
01
—
P00442979
RAILROAD MEDICARE
TX
01
—
P01036906
RR MEDICARE
TX
Enumeration date
07/26/2005
Last updated
04/22/2019
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