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1487659876

NPI Code Detail

MEDICARE: DR. MARK BRENDAN REEDY X MD

MEDICARE: DR. MARK BRENDAN REEDY X MD

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	207VX0201X	Gynecologic Oncology Physician	H8348	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	H08KE62101	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1487659876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BRENDAN REEDY X MD

Provider Business Mailing Address
First Line	:	6107 88TH PL
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-0839
Country	:	US
Telephone Number	:	325-665-0118
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 INDIANA AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79415-3364
Country	:	US
Telephone Number	:	806-775-8600
Fax Number	:	806-775-8586

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/16/2021

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Directions to “ DR. MARK BRENDAN REEDY X MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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