Healthcare Provider Details

I. General information

NPI: 1427007194
Provider Name (Legal Business Name): GREG MICHAEL REGER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER BLDG 9040 FITZSIMMONS DRIVE
FORT LEWIS WA
98433
US

IV. Provider business mailing address

10902 103RD AVENUE CT SW
LAKEWOOD WA
98498-1708
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: