Healthcare Provider Details

I. General information

NPI: 1073804209
Provider Name (Legal Business Name): ZACHARY DAVID REARDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

IV. Provider business mailing address

4752 OLD SHELL RD
MOBILE AL
36608-2333
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-1895
  • Fax:
Mailing address:
  • Phone: 239-851-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35016
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: