Basic Information
| Provider Information | |||||||||
| NPI: | 1225000995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REAGAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538358040 | ||||||||
| FaxNumber: | 2538358035 | ||||||||
| Practice Location | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538358040 | ||||||||
| FaxNumber: | 2538358035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 08/23/2012 | ||||||||
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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 | 207RC0000X | MD00015641 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P07544 | 01 | WA | PIERCE COUNTY | OTHER | 1224906 | 05 | WA | MEDICAID | 0239786 | 01 | WA | STATE L&I | OTHER | 0296244 | 01 | WA | L&I | OTHER | 7543RD | 01 | WA | INDIVIDUAL BLUE SHIELD | OTHER | MD5069W | 01 | WA | ALASKA MEDICAID | OTHER |