MEDICARE: PATRICK RAY REARDON MD

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	208600000X	Surgery Physician	G5518	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01036906	OTHER	TX	RR MEDICARE
7	P00442979	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8AC476	OTHER	TX	BLUE CROSS BLUE SHIELD
4	8AC476	OTHER	TX	BCBS
5	8DY834	OTHER	TX	BLUE CROSS BLUE SHIELD
6	8G5880	OTHER	TX	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649270265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK RAY REARDON MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST STE 2435
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2767
Country	:	US
Telephone Number	:	713-790-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 2435
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-790-3140
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	04/22/2019

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Directions to “ PATRICK RAY REARDON MD” Practice Location

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