Provider Demographics
NPI:1235195017
Name:REICHARD, GARY F (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:REICHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVENUE #300
Mailing Address - Street 2:COMMUNITY HEALTH CARE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-722-1540
Mailing Address - Fax:253-597-4556
Practice Address - Street 1:1202 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:COMMUNITY HEALTH CARE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3926
Practice Address - Country:US
Practice Address - Phone:253-441-4742
Practice Address - Fax:253-597-4556
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31705207Q00000X
WAMD60404371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ793738Medicaid
AZ793738Medicaid
AZZ83748Medicare PIN