Provider Demographics
NPI:1780920249
Name:SAVOIE, REGINALD W (NP)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:W
Last Name:SAVOIE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5531 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1788
Mailing Address - Country:US
Mailing Address - Phone:409-543-3688
Mailing Address - Fax:409-985-5233
Practice Address - Street 1:8599 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8023
Practice Address - Country:US
Practice Address - Phone:409-983-7711
Practice Address - Fax:409-985-5233
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX635580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
265625OtherMEDICARE PTAN
TX311819204Medicaid