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General NPI Number Information
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NPI Number | 1891984696
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Entity Type | Organization
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Legal Business Name | REAGAN CROSSNOE M.D P.A.
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 7120 SW 9TH AVE
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City | AMARILLO
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State | TX
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Zip | 79106-1704
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Country | US
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Telephone | 806-547-0330
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Fax | 806-547-0331
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Provider Business Mailing Address
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Address Line | 7120 SW 9TH AVE
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City | AMARILLO
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State | TX
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Zip | 79106-1704
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Country | US
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Telephone | 806-547-0330
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Fax | 806-547-0331
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Authorized Official
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Title or Position | PHYSICIAN
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Name | REAGAN LEE CROSSNOE
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Credential | M.D.
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Telephone | 806-547-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | K9511
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License Number State | TX
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