Basic Information
| Provider Information | |||||||||
| NPI: | 1538412325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NBHC INDIAN HEAD 4141 W WILSON RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | INDIAN HEAD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017444604 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 W HIGHWAY 98 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325120003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505056472 | ||||||||
| FaxNumber: | 8505056501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 207Q00000X | MD.33205 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.