Individual
JOSEPH D PHANEUF
Active
Individual
JOSEPH D PHANEUF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00036029
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1103936
—
WA
01
—
121414
L & I
—
05
—
8473381
—
WA
01
—
CG4026
MEDCIARE RR GROUP
WA
01
—
G000362000
MEDICARE GROUP NUMBER
WA
01
—
P00395895
MEDICARE RR NUMBER
WA
Enumeration date
09/01/2006
Last updated
06/24/2021
Update your record
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