MEDICARE: JAMES P REARDON M.D.

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	174400000X	Specialist	106191	MO
2	332B00000X	Durable Medical Equipment & Medical Supplies	106191	MO
3	335E00000X	Prosthetic/Orthotic Supplier	106191	MO

General Provider Information

NPI Number	:	1891889978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES P REARDON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1520
Second Line	:	STE 1230
City	:	THE DALLES
State	:	OR
Zip	:	97058-8003
Country	:	US
Telephone Number	:	541-298-7971
Fax Number	:	541-296-6431

Provider Business Practice Location Address
First Line	:	2790 CLAY EDWARDS DR
Second Line	:	STE 1230
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3276
Country	:	US
Telephone Number	:	816-214-9300
Fax Number	:	816-214-9330

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/28/2016

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Directions to “ JAMES P REARDON M.D.” Practice Location

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