Individual
DOUGLAS BRENT RUTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
100 E 33RD ST STE 206, VANCOUVER, WA 98663-2776
(360) 695-1334
(360) 992-1159
Mailing address
100 E 33RD ST STE 206, VANCOUVER, WA 98663-2776
(360) 695-1334
(360) 992-1159
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P0515
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050259000
BC
—
01
—
164425100000
PREMARA
—
05
—
2047640
—
WA
01
—
480014538
RR MCR
—
Enumeration date
08/26/2005
Last updated
06/29/2021
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