Provider Demographics
NPI:1891889978
Name:REARDON, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:REARDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:STE 1230
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-8003
Mailing Address - Country:US
Mailing Address - Phone:541-298-7971
Mailing Address - Fax:541-296-6431
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:STE 1230
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-214-9300
Practice Address - Fax:816-214-9330
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-07-28
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Provider Licenses
StateLicense IDTaxonomies
MO106191174400000X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87027Medicare UPIN