Healthcare Provider Details

I. General information

NPI: 1396789244
Provider Name (Legal Business Name): STEVEN REYES WOOD IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 THRESHER AVE USS NEBRASKA SSBN 739 BLUE
SILVERDALE WA
98315-2103
US

IV. Provider business mailing address

4055 REDWING TRL NW
BREMERTON WA
98312-9616
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4210
  • Fax: 360-396-4247
Mailing address:
  • Phone: 360-315-4210
  • Fax: 360-396-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: