Provider Demographics
NPI:1275816910
Name:FAMILY DERMATOLOGY CO
Entity Type:Organization
Organization Name:FAMILY DERMATOLOGY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REESE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIEK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-682-5024
Mailing Address - Street 1:275 SE CABOT DR STE A3
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3740
Mailing Address - Country:US
Mailing Address - Phone:360-682-5024
Mailing Address - Fax:360-682-5749
Practice Address - Street 1:275 SE CABOT DR STE A3
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3740
Practice Address - Country:US
Practice Address - Phone:360-682-5024
Practice Address - Fax:360-682-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603137655OtherUBI