Provider Demographics
NPI:1558369959
Name:REITER, BLAKE E (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:E
Last Name:REITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16499 PEARSON POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8058
Mailing Address - Country:US
Mailing Address - Phone:360-271-2846
Mailing Address - Fax:
Practice Address - Street 1:9800 LEVIN RD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7849
Practice Address - Country:US
Practice Address - Phone:360-692-2728
Practice Address - Fax:360-692-6009
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8156820Medicaid
WA0217857OtherLABOR AND INDUSTRIES
WA204509683OtherUS DEPT OF LABOR
WA743353001OtherGROUP HEALTH
WA204509683OtherPREMERA BLUE CROSS
WA20450968301OtherKPS
WA8719REOtherREGENCE
WAE53783Medicare UPIN
WA20450968301OtherKPS