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General NPI Number Information
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NPI Number | 1124168778
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Entity Type | Organization
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Legal Business Name | BAINBRIDGE ANESTHESIA ASSOCIATES PS
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 9800 LEVIN RD NW SUITE 102
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City | SILVERDALE
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State | WA
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Zip | 98383-7856
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Country | US
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Telephone | 360-692-2728
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Fax | 425-609-0599
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Provider Business Mailing Address
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Address Line | 6003 23RD DR W STE 100
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City | EVERETT
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State | WA
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Zip | 98203-1583
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Country | US
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Telephone | 425-407-1500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BLAKE EDWARD REITER
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Credential | M.D.
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Telephone | 360-271-2846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00023941
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License Number State | WA
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