Individual
REGGIE A VADEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1601 E BROADWAY, STE240, COLUMBIA, MO 65201-8020
(573) 815-8145
(573) 815-3832
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(573) 815-8145
(573) 815-3832
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2014008946
MO
208600000X
Surgery Physician
40886
IA
208C00000X
Colon & Rectal Surgery Physician
Primary
2014008945
MO
208C00000X
Colon & Rectal Surgery Physician
K8545
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037011602
—
TX
05
—
037011603
—
TX
05
—
037011604
—
TX
05
—
037011605
—
TX
05
—
1700983343
—
MO
01
—
2014008945
MO STATE LICENSE
MO
Enumeration date
09/17/2006
Last updated
02/07/2017
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