1396789244 NPI number — MR. STEVEN REYES WOOD IDC

Table of content: MR. STEVEN REYES WOOD IDC (NPI 1396789244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396789244 NPI number — MR. STEVEN REYES WOOD IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
STEVEN
Provider Middle Name:
REYES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396789244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4055 REDWING TRL NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98312-9616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-315-4210
Provider Business Mailing Address Fax Number:
360-396-4247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 THRESHER AVE
Provider Second Line Business Practice Location Address:
USS NEBRASKA SSBN 739 BLUE
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98315-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-315-4210
Provider Business Practice Location Address Fax Number:
360-396-4247
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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