Healthcare Provider Details

I. General information

NPI: 1417983198
Provider Name (Legal Business Name): JEAN PATRICIA REID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

IV. Provider business mailing address

4915 25TH AVE NE STE 102W
SEATTLE WA
98105-5667
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4511
  • Fax: 360-716-5782
Mailing address:
  • Phone: 206-999-4068
  • Fax: 206-693-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00033023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: