Healthcare Provider Details

I. General information

NPI: 1326183112
Provider Name (Legal Business Name): ROBERT JOHN REID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 MINOR AVE SUITE 1600
SEATTLE WA
98101-1498
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 206-287-2071
  • Fax: 206-287-2871
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD00041905
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: