Basic Information
Provider Information | |||||||||
NPI: | 1760512974 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REAMER | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1939 E BURNSIDE ST | ||||||||
Address2: |   | ||||||||
City: | PORTLAND | ||||||||
State: | OR | ||||||||
PostalCode: | 972141535 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5032336141 | ||||||||
FaxNumber: | 5032332889 | ||||||||
Practice Location | |||||||||
Address1: | 675 N 5TH ST STE A | ||||||||
Address2: |   | ||||||||
City: | JACKSONVILLE | ||||||||
State: | OR | ||||||||
PostalCode: | 975309659 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5418999194 | ||||||||
FaxNumber: | 5418991519 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/06/2007 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAS-P-1006131 | OR | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 212936 | 05 | OR |   | MEDICAID | 2432417000 | 01 |   | FEDERAL WORKERS COMP | OTHER |