MEDICARE: GARY L. REA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	60167344	WA

General Provider Information

NPI Number	:	1629063664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY L. REA MD

Provider Business Mailing Address
First Line	:	PO BOX 3007
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98114-3007
Country	:	US
Telephone Number	:	206-788-3500
Fax Number	:	206-652-5216

Provider Business Practice Location Address
First Line	:	3815 S OTHELLO ST FL 2
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3510
Country	:	US
Telephone Number	:	206-788-3500
Fax Number	:	206-652-5216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	11/27/2018

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