MEDICARE: DR. PATRICK JOHN REGAN D.O.

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	208600000X	Surgery Physician	OS 7803	FL

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

General Provider Information

NPI Number	:	1639270085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK JOHN REGAN D.O.

Provider Business Mailing Address
First Line	:	2402 FRIST BLVD STE 204
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-462-3939
Fax Number	:	772-462-3938

Provider Business Practice Location Address
First Line	:	2402 FRIST BLVD STE 204
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-462-3939
Fax Number	:	772-462-3938

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. PATRICK JOHN REGAN D.O.” Practice Location

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