MEDICARE: JEFFREY M REAGAN MD PLLC

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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	49407	AZ

General Provider Information

NPI Number	:	1194132613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY M REAGAN MD PLLC

Provider Business Mailing Address
First Line	:	4830 HIGHWAY 260 STE 103
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5851
Country	:	US
Telephone Number	:	928-537-8777
Fax Number	:	928-537-1914

Provider Business Practice Location Address
First Line	:	4830 HIGHWAY 260 STE 103
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5851
Country	:	US
Telephone Number	:	928-537-8777
Fax Number	:	928-537-1914

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JAMIE BARNETT
Credential	:
Telephone Number	:	928-537-8777

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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