Street, Reagan Michelle
Street, Reagan Michelle is an individual health care provider with primary practice located at 1001 12Th Ave Suite 200, Fort Worth TX 76104-3926. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Gynecologic Oncology. Allopathic & Osteopathic Physicians / Gynecologic Oncology is her primary health care specialty. Street, Reagan Michelle can be contacted via phone (817) 850-2000.Contact Information
Primary practice address
1001 12Th Ave Suite 200
Fort Worth TX 76104-3926
Phone: (817) 850-2000
Fax: (817) 850-2015
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | N-3333 | Texas |
| Allopathic & Osteopathic Physicians / Gynecologic Oncology | 207VX0201X | N3333 | Texas |
Profile Details
| NPI number | 1487845673 |
|---|---|
| LBN Legal business name | Street, Reagan Michelle |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 5th, 2007 |
| Last updated | Oct 3rd, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487845673 | NPPES |
| Texas | MEDICAID | 204651802 | |
| Texas | Other | 2766284705 |
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