Individual
DR. BENIGNO WALDO A DAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1420 MAIN ST, SUMNER, WA 98390
(253) 987-5156
(253) 987-5462
Mailing address
1420 MAIN ST, SUMNER, WA 98390
(253) 987-5156
(253) 987-5462
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00036169
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0185591
L & I PROVIDER NUMBER
WA
05
—
2004507
—
WA
01
—
5496722
AETNA PROVIDER NUMBER
WA
01
—
911203494BP
KPS PROVIDER NUMBER
WA
01
—
98390A015
TRICARE PROVIDER NUMBER
WA
01
—
9869DA
REGENCE RIDER NUMBER
WA
Enumeration date
05/19/2006
Last updated
05/10/2011
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