Individual
DOUGLAS EDISON WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
301 W POPLAR ST, STE 220, WALLA WALLA, WA 99362-2858
(509) 522-1030
(509) 529-6066
Mailing address
PO BOX 32, LIBERTY LAKE, WA 99019-0032
(509) 529-8905
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003131
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500604784
—
OR
05
—
806824800
—
ID
05
—
8377525
—
WA
Enumeration date
05/01/2006
Last updated
03/01/2021
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