Provider Demographics
NPI:1104853365
Name:REGAN, TYCE LEE (MD)
Entity Type:Individual
Prefix:
First Name:TYCE
Middle Name:LEE
Last Name:REGAN
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 1:3315 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1827
Mailing Address - Country:US
Mailing Address - Phone:713-944-5151
Mailing Address - Fax:
Practice Address - Street 1:3315 BURKE RD
Practice Address - Street 2:#300
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1827
Practice Address - Country:US
Practice Address - Phone:713-944-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4471207L00000X
TXK8943207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134689208Medicaid
TX8M7865OtherBC/BS
TX10869630OtherPPO NEXT HHPO
G31235Medicare UPIN
TX8C6738Medicare PIN