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Individual
DOUGLAS BRENT RUTAN
Active
Individual
DOUGLAS BRENT RUTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P0515
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050259000
BC
—
01
—
164425100000
PREMARA
—
05
—
2047640
—
WA
01
—
480014538
RR MCR
—
Enumeration date
08/26/2005
Last updated
06/29/2021
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