Provider Demographics
NPI:1760482475
Name:REARDON, MATTHEW JOSEPH (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:REARDON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3901
Mailing Address - Country:US
Mailing Address - Phone:702-227-1835
Mailing Address - Fax:702-227-4796
Practice Address - Street 1:6 OFFICE PARK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2512
Practice Address - Country:US
Practice Address - Phone:205-795-3125
Practice Address - Fax:205-795-3001
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL227412083P0500X
NV13742208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51510445OtherBLUECROSS BLUESHIELD