MEDICARE: HEATHER REAGIN DO

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	207N00000X	Dermatology Physician	R5190	TX
2	207NS0135X	Procedural Dermatology Physician	R5190	TX

General Provider Information

NPI Number	:	1407260151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER REAGIN DO

Provider Business Mailing Address
First Line	:	7300 RANCH ROAD 2222
Second Line	:	BLDG 1, STE 200
City	:	AUSTIN
State	:	TX
Zip	:	78730
Country	:	US
Telephone Number	:	512-628-0465
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 E BAILEY BOSWELL RD
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3575
Country	:	US
Telephone Number	:	817-529-1400
Fax Number	:

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	01/22/2024

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Directions to “ HEATHER REAGIN DO” Practice Location

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