Basic Information
Provider Information
NPI: 1679543789
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REECE
FirstName: WILLIAM
MiddleName: BRENT
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4225 CAMPUS GREEN LOOP NE
Address2:  
City: LACEY
State: WA
PostalCode: 985166243
CountryCode: US
TelephoneNumber: 3604551143
FaxNumber: 2539681261
Practice Location
Address1: MADIGAN ARMY MEDICAL CENTER
Address2: 9040 REID ST., ATTN: MCHJ-QCR
City: TACOMA
State: WA
PostalCode: 984310001
CountryCode: US
TelephoneNumber: 2539682252
FaxNumber: 2539683278
Other Information
ProviderEnumerationDate: 01/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XMD00034496WAY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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