MEDICARE: ADRIANNE REAGAN AA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant		GA
2	367H00000X	Anesthesiologist Assistant	801	TX

General Provider Information

NPI Number	:	1053507129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANNE REAGAN AA-C

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 OVERPASS RD STE 110
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-2300
Country	:	US
Telephone Number	:	737-999-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	01/26/2023

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Directions to “ ADRIANNE REAGAN AA-C” Practice Location

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