Basic Information
| Provider Information | |||||||||
| NPI: | 1104853365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGAN | ||||||||
| FirstName: | TYCE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3315 BURKE RD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139445151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3315 BURKE RD | ||||||||
| Address2: | #300 | ||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139445151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | J4471 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | K8943 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 134689208 | 05 | TX | MEDICAID | 8M7865 | 01 | TX | BC/BS | OTHER | 10869630 | 01 | TX | PPO NEXT HHPO | OTHER |