Provider Demographics
NPI:1558642439
Name:REAGAN, JOSEPH OREN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:OREN
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 1:3882 HENNEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-8610
Mailing Address - Country:US
Mailing Address - Phone:315-682-5590
Mailing Address - Fax:315-682-2463
Practice Address - Street 1:3882 HENNEBERRY RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-8610
Practice Address - Country:US
Practice Address - Phone:315-682-5590
Practice Address - Fax:315-682-2463
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY145529207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology