Healthcare Provider Details

I. General information

NPI: 1790077253
Provider Name (Legal Business Name): CHRISTOPHER AARON BREED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 15TH AVE SE
PUYALLUP WA
98372
US

IV. Provider business mailing address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-1310
  • Fax:
Mailing address:
  • Phone: 253-403-1085
  • Fax: 253-403-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberFB5259216
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301098193
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: