Provider Demographics
NPI:1316088834
Name:WASHINGTON, REUBEN JAMES (MD,PC)
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:JAMES
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5075
Mailing Address - Country:US
Mailing Address - Phone:623-242-6037
Mailing Address - Fax:
Practice Address - Street 1:901 W ORCHARD LN
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5075
Practice Address - Country:US
Practice Address - Phone:623-242-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00500578Medicaid
NY10795AMedicare ID - Type UnspecifiedPROVIDER NUMBER
NYB72442Medicare UPIN