MEDICARE: JOHN REAGAN DPM

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	213E00000X	Podiatrist	8716994-0501	UT

General Provider Information

NPI Number	:	1275896359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN REAGAN DPM

Provider Business Mailing Address
First Line	:	731 SKIPTON
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-6071
Country	:	US
Telephone Number	:	801-842-6058
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 SKIPTON
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-6071
Country	:	US
Telephone Number	:	801-842-6058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	01/19/2016

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