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Individual

DEAN KIRK DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1112 6TH AVE, STE 300, TACOMA, WA 98405-4040
(253) 272-2224
(253) 572-4624
Mailing address
1112 6TH AVE, STE 300, TACOMA, WA 98405-4040
(253) 272-2224
(253) 572-4624

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10005076
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0214034
STATE L&I
WA
05
8466047
WA
01
8942898
STATE CRIME VICTIMS
WA
01
P00354460
MEDICARE RAILROAD
WA
Enumeration date
08/17/2006
Last updated
11/10/2010
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