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NPI Code Detail

MEDICARE: MATTHEW JOSEPH REARDON M.D., MPH

MEDICARE:   MATTHEW JOSEPH REARDON  M.D., MPH
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
12083P0500XPreventive Medicine/Occupational Environmental Medicine Physician22741AL
2208D00000XGeneral Practice Physician13742NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151510445OTHERALBLUECROSS BLUESHIELD

General Provider Information

NPI Number : 1760482475
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JOSEPH REARDON M.D., MPH
Provider Business Mailing Address
First Line : 151 W BROOKS AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3901
Country : US
Telephone Number : 702-227-1835
Fax Number : 702-227-4796
Provider Business Practice Location Address
First Line : 6 OFFICE PARK CIR
Second Line : SUITE 100
City : BIRMINGHAM
State : AL
Zip : 35223-2512
Country : US
Telephone Number : 205-795-3125
Fax Number : 205-795-3001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 05/23/2016

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