Basic Information
| Provider Information | |||||||||
| NPI: | 1093937054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLDRIDGE | ||||||||
| FirstName: | REGAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 N STEPHANIE ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890146692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029523350 | ||||||||
| FaxNumber: | 7029523365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 WIGWAM PKWY STE 130 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028561400 | ||||||||
| FaxNumber: | 7028561401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 042-0011321 | VT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 12846 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 371315 | 05 | AZ | MEDICAID |