Provider Demographics
NPI:1083604086
Name:CROSSNOE, REAGAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:LEE
Last Name:CROSSNOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 SW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1704
Mailing Address - Country:US
Mailing Address - Phone:806-547-0330
Mailing Address - Fax:806-547-0331
Practice Address - Street 1:7120 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1704
Practice Address - Country:US
Practice Address - Phone:806-547-0330
Practice Address - Fax:806-547-0331
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9511207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE00820587843OtherAETNA
TXP00010069OtherRAILROAD MEDICARE
0090JUOtherBLUE CROSS BLUE SHIELD
TX157236401Medicaid
TXE00820587843OtherAETNA