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General NPI Number Information
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NPI Number | 1073804209
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Entity Type | Individual
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Provider Name | ZACHARY DAVID REARDON MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 168 MOBILE INFIRMARY BLVD
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City | MOBILE
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State | AL
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Zip | 36607-3510
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Country | US
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Telephone | 251-433-1895
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Fax |
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Provider Business Mailing Address
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Address Line | 4752 OLD SHELL RD
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City | MOBILE
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State | AL
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Zip | 36608-2333
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Country | US
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Telephone | 239-851-2271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35016
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License Number State | AL
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