Provider Demographics
NPI:1225000995
Name:REAGAN, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:REAGAN
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 1:34503 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8727
Mailing Address - Country:US
Mailing Address - Phone:253-835-8040
Mailing Address - Fax:253-835-8035
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-835-8040
Practice Address - Fax:253-835-8035
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015641207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP07544OtherPIERCE COUNTY
WA1224906Medicaid
WA0239786OtherSTATE L&I
WA0296244OtherL&I
WA7543RDOtherINDIVIDUAL BLUE SHIELD
WAMD5069WOtherALASKA MEDICAID
G8875770Medicare PIN
WAMD5069WOtherALASKA MEDICAID
WA7543RDOtherINDIVIDUAL BLUE SHIELD