Organization
BEACH CLINIC INC P S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY J DUEBER D.O. (PHYSICIAN)
(360) 268-0195
Entity
Organization
Contact information
Practice address
801 N. MONTESANO, WESTPORT, WA 98595
(360) 268-0195
(360) 268-1442
Mailing address
801 N MONTESANO, PO BOX 2229, WESTPORT, WA 98595
(360) 268-0195
(360) 268-1442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP00001807
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7102221
—
WA
05
—
7103187
—
WA
Enumeration date
06/14/2007
Last updated
12/07/2010
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