Provider Demographics
NPI:1912915406
Name:REEDY, R GRAHAM GRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:R GRAHAM
Middle Name:GRAHAM
Last Name:REEDY
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 1:1314 8TH ST NE
Mailing Address - Street 2:#101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002
Mailing Address - Country:US
Mailing Address - Phone:253-804-2788
Mailing Address - Fax:253-804-2498
Practice Address - Street 1:1314 8TH ST NE
Practice Address - Street 2:#101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-804-2788
Practice Address - Fax:253-804-2498
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080169199OtherRR MEDICARE
WA146151OtherFAA
WA1137702Medicaid
WA146151OtherFAA
WA0104416Medicare ID - Type Unspecified
WAA-55143Medicare UPIN