Healthcare Provider Details

I. General information

NPI: 1861504573
Provider Name (Legal Business Name): JOSEPH PAUL REOUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY VAPSHCS/116-ATC
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY VAPSHCS/116-ATC
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 206-277-1747
  • Fax:
Mailing address:
  • Phone: 206-277-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD00033713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: