Provider Demographics
NPI:1124455308
Name:REAGOR, RAELENE C
Entity type:Individual
Prefix:
First Name:RAELENE
Middle Name:C
Last Name:REAGOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 N UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74130
Mailing Address - Country:US
Mailing Address - Phone:405-535-0226
Mailing Address - Fax:
Practice Address - Street 1:5337 N UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74130-1721
Practice Address - Country:US
Practice Address - Phone:405-535-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management