Provider Demographics
NPI:1417983198
Name:REID, JEAN PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:PATRICIA
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 25TH AVE NE STE 102W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5667
Mailing Address - Country:US
Mailing Address - Phone:206-999-4068
Mailing Address - Fax:206-693-3915
Practice Address - Street 1:7520 TOTEM BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6160
Practice Address - Country:US
Practice Address - Phone:360-716-4511
Practice Address - Fax:360-716-5782
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0884REOtherREGENCE BS
WA0190647OtherLABOR & INDUSTRIES
WA1100122Medicaid
WA91-2145894OtherPREMERA BC QAFM
WA0190647OtherL & I QAFM
WA91-2145894OtherCOMMERCIAL QAFM
WA0190647OtherLABOR & INDUSTRIES
WA91-2145894OtherPREMERA BC QAFM
WA8806723Medicare PIN
WA8806723Medicare ID - Type UnspecifiedMEDICARE QAFM