Basic Information
| Provider Information | |||||||||
| NPI: | 1922070820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REINHART | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19365 7TH AVENUE NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607795556 | ||||||||
| FaxNumber: | 3606972514 | ||||||||
| Practice Location | |||||||||
| Address1: | 19365 7TH AVENUE NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607795556 | ||||||||
| FaxNumber: | 3606972514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD 00016732 | WA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 1523703 | 05 | WA | MEDICAID |