Provider Demographics
NPI:1487659876
Name:REEDY, MARK BRENDAN X (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRENDAN
Last Name:REEDY
Suffix:X
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 1:6107 88TH PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0839
Mailing Address - Country:US
Mailing Address - Phone:325-665-0118
Mailing Address - Fax:
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-8600
Practice Address - Fax:806-775-8586
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8348207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122327308Medicaid
TX122327315Medicaid
TX122327306Medicaid
TXH08KE62101OtherBCBS
TX8L7895Medicare PIN
TXF71874Medicare UPIN