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Individual

DR. MARIO DODDS ROSALES SIMANGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
800 WEST MAPLE STREET, MEDICAL LAKE, WA 99022-0800
(509) 565-4000
(509) 565-7015
Mailing address
PO BOX 800, 800 WEST MAPLE STREET, MEDICAL LAKE, WA 99022-0800
(509) 565-4000
(509) 565-7015

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00021981
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1087626
WA
Enumeration date
11/16/2005
Last updated
01/13/2015
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