Provider Demographics
NPI:1396789244
Name:WOOD, STEVEN REYES (IDC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:REYES
Last Name:WOOD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4055 REDWING TRL NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-9616
Mailing Address - Country:US
Mailing Address - Phone:360-315-4210
Mailing Address - Fax:360-396-4247
Practice Address - Street 1:2100 THRESHER AVE
Practice Address - Street 2:USS NEBRASKA SSBN 739 BLUE
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-2103
Practice Address - Country:US
Practice Address - Phone:360-315-4210
Practice Address - Fax:360-396-4247
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman