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NPI Code Detail

MEDICARE: DR. MARK REGER PH.D.

MEDICARE: DR. MARK REGER PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY00002984WA
2103G00000XClinical NeuropsychologistPY2984WA

General Provider Information

NPI Number : 1891760849
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK REGER PH.D.
Provider Business Mailing Address
First Line : 9600 VETERANS DR SW
Second Line : BLDG 61
City : TACOMA
State : WA
Zip : 98493-0003
Country : US
Telephone Number : 253-583-3295
Fax Number :
Provider Business Practice Location Address
First Line : 9600 VETERANS DR SW
Second Line : BLDG 61
City : TACOMA
State : WA
Zip : 98493-0003
Country : US
Telephone Number : 253-583-3295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 11/05/2015

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