Healthcare Provider Details

I. General information

NPI: 1497739668
Provider Name (Legal Business Name): RUTH ANN REARDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 W BEEBE CAPPS EXPY
SEARCY AR
72143-5012
US

IV. Provider business mailing address

1915 W BEEBE CAPPS EXPY
SEARCY AR
72143-5012
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-8175
  • Fax: 501-268-8337
Mailing address:
  • Phone: 501-268-8175
  • Fax: 501-268-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2006-01883
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE-5277
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2007026053
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD0000044093
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20916
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: