Provider Demographics
NPI:1376588194
Name:POLONE, REGAN W (PA)
Entity Type:Individual
Prefix:MR
First Name:REGAN
Middle Name:W
Last Name:POLONE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-793-5130
Mailing Address - Fax:325-793-5133
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5265
Practice Address - Country:US
Practice Address - Phone:325-793-5130
Practice Address - Fax:325-793-5133
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS66763Medicare UPIN
TX82N135Medicare PIN