Provider Demographics
NPI:1497739668
Name:REARDON, RUTH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:REARDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5012
Mailing Address - Country:US
Mailing Address - Phone:501-268-8175
Mailing Address - Fax:501-268-8337
Practice Address - Street 1:1915 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5012
Practice Address - Country:US
Practice Address - Phone:501-268-8175
Practice Address - Fax:501-268-8337
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01883207ZP0102X
ARE-5277207ZP0102X
MO2007026053207ZP0102X
TNMD0000044093207ZP0102X
MS20916207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5N951OtherBCBS
AR165452001Medicaid
AR5N951Medicare UPIN