MEDICARE: RYAN SCOTT 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	207X00000X	Orthopaedic Surgery Physician	N6607	TX
2	207XS0106X	Orthopaedic Hand Surgery Physician	N6607	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00850287	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982831624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SCOTT REARDON M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-877-3280

Provider Business Practice Location Address
First Line	:	801 W. TERRELL AVE.
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3100
Country	:	US
Telephone Number	:	817-877-3277
Fax Number	:	817-877-3280

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

Provider Enumeration Date	:	06/21/2009
Last Update Date	:	09/30/2011

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Directions to “ RYAN SCOTT REARDON M.D.” Practice Location

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