Provider Demographics
NPI:1245281179
Name:REGAN, TERRENCE C (MD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:C
Last Name:REGAN
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:523-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:21 HOSPITAL DR STE 140
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-445-8530
Practice Address - Fax:386-446-5087
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073545208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
41513OtherBLUE SHIELD
41513OtherBLUE SHIELD
41513OtherBLUE SHIELD
1900173OtherUNITED HEALTHCARE
41513OtherBLUE SHIELD
FL41513ZMedicare PIN