Individual
DR. THEODORE P SKAARUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1804 W 51ST AVE, KENNEWICK, WA 99337-4626
(509) 619-0562
Mailing address
PO BOX 1663, WALLA WALLA, WA 99362-0031
(509) 619-0562
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00037267
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050066021
RAILROAD MEDICARE
WA
05
—
139398
—
OR
05
—
8240079
—
WA
Enumeration date
06/16/2005
Last updated
10/27/2014
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