MEDICARE: MR. PHIL REEDY PA

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	363AM0700X	Medical Physician Assistant	P402756	TX

General Provider Information

NPI Number	:	1801876479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHIL REEDY PA

Provider Business Mailing Address
First Line	:	1707 BROADMOOR DR
Second Line	:	SUITE 100
City	:	BRYAN
State	:	TX
Zip	:	77802-5233
Country	:	US
Telephone Number	:	979-776-7767
Fax Number	:	979-774-4986

Provider Business Practice Location Address
First Line	:	1707 BROADMOOR DR
Second Line	:	SUITE 100
City	:	BRYAN
State	:	TX
Zip	:	77802-5233
Country	:	US
Telephone Number	:	979-776-7767
Fax Number	:	979-774-4986

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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