Healthcare Provider Details

I. General information

NPI: 1235195017
Provider Name (Legal Business Name): GARY F. REICHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MARTIN LUTHER KING JR WAY COMMUNITY HEALTH CARE
TACOMA WA
98405-3926
US

IV. Provider business mailing address

1019 PACIFIC AVENUE #300 COMMUNITY HEALTH CARE
TACOMA WA
98402
US

V. Phone/Fax

Practice location:
  • Phone: 253-441-4742
  • Fax: 253-597-4556
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31705
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60404371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: