Provider Demographics
NPI:1972504629
Name:SANDY, REGINALD (DO)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:SANDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:520 S 7TH ST STE SB406
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-8770
Practice Address - Fax:812-885-8771
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP598207RG0100X
IN02001472207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ3764001OtherMEDICARE
IN100427420AMedicaid
IN200002550Medicaid
444170BMedicare ID - Type Unspecified
IN100427420AMedicaid