DEAN KIRK DOUGLAS (NPI# 1053424333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053424333 |
| Entity Type | Individual |
| Full Name | DEAN KIRK DOUGLAS |
| Credential | PA-C |
| Practice Address |
1112 6th Ave Ste 300 Tacoma WA 98405-4040 |
| Practice Telephone | 2532722224 |
| Practice Fax Number | 2535724624 |
| Mailing Telephone | 2532722224 |
| Mailing Fax Number | 2535724624 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-11-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA10005076 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | STATE L&I | 0214034 | 01 |
| WA | 8466047 | 05 | |
| WA | STATE CRIME VICTIMS | 8942898 | 01 |
| WA | MEDICARE RAILROAD | P00354460 | 01 |
| Street Address |
1112 6TH AVE STE 300 |
| City | TACOMA |
| State | WA |
| Zip Code | 98405-4040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174512503 | Tasc LLC | Clinic/Center | 1112 6th Ave, Suite 100, Tacoma, WA 98405-4040 | 2005-10-18 |
| 1780136481 | Ashley Maria Mccullough | Registered Nurse | 1112 6th Ave, Suite310, Tacoma, WA 98405-4040 | 2016-10-28 |
| 1962952036 | Eunjin Lipton | Nurse Practitioner | 1112 6th Ave, Ste. 301, Tacoma, WA 98405-4040 | 2016-10-12 |
| 1538589072 | Alisha Scott | Physician Assistant | 1112 6th Ave, Ste 200, Tacoma, WA 98405-4040 | 2014-04-23 |
| 1235400920 | Rbs Anesthesia Services LLP | Anesthesiology | 1112 6th Ave, Suite 100, Tacoma, WA 98405-4040 | 2012-01-26 |
| 1871873562 | Franciscan Medical Group | Internal Medicine | 1112 6th Ave, Ste 200, Tacoma, WA 98405-4040 | 2011-08-25 |
| 1346455987 | Rosalie Nguyen | Pharmacist | 1112 6th Ave, Ste 101, Tacoma, WA 98405-4040 | 2007-05-14 |
| 1134255938 | Kathryn Thena Matthews | Physician Assistant | 1112 6th Ave, Ste 300, Tacoma, WA 98405-4048 | 2007-02-26 |
| 1801974076 | Steven Larson | Internal Medicine | 1112 6th Ave, Ste 200, Tacoma, WA 98405-4040 | 2006-11-02 |
| 1508871294 | Franciscan Medical Group | Orthopaedic Surgery | 1112 6th Ave, #300, Tacoma, WA 98405-4040 | 2006-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609486026 | Joanna Christine Hope | Physician Assistant | 2502 S Union Avenue, Tacoma, WA 98405 | 2020-08-01 |
| 1467077891 | Richard Jimenez | Student in an Organized Health Care Education/Training Program | 1202 M.l.k. Jr Way Suite #310, Tacoma, WA 98405 | 2020-06-11 |
| 1669008785 | Mariana Sanchez Corona | Behavior Technician | 1901 S Union Ave Allenmore Building B, Tacoma, WA 98405 | 2020-03-20 |
| 1811534845 | Jasmine Gregory | Social Worker | 311 Martin Luther King Jr. Way, Ms:315-c2-php, Tacoma, WA 98405 | 2019-12-10 |
| 1548807506 | Holly Rebecca Brezynski | Student in an Organized Health Care Education/Training Program | Fresenius Kindney Care - Home Therapies Department, 1717 South J Street, Tacoma, WA 98405 | 2019-12-09 |
| 1972064392 | Logan Brau | Student in an Organized Health Care Education/Training Program | 1202 M.l.k. Jr Way, Tacoma, WA 98405 | 2019-03-28 |
| 1629532536 | Preferred Orthotic and Prosthetic Services Inc | Prosthetic/Orthotic Supplier | 1708 Yakima Ave Ste 60, Tacoma, WA 98405 | 2019-01-24 |
| 1669945911 | Heidi Weakley | Counselor | 1001 S Yakima Ave, Suite 5, Tacoma, WA 98405 | 2019-01-09 |
| 1972074011 | Taviance Benet Laster | Behavior Technician | 1416 S 9th St, Tacoma, WA 98405 | 2018-12-16 |
| 1336618040 | Bailey Bangerter | Physician Assistant | 1901 South Union, A-233, Tacoma, WA 98405 | 2018-11-26 |
| Find all providers in zip 98405 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124147087 | Aniko A Szentes | Physician Assistant | 3708 55th St Ne, Tacoma, WA 98422-4571 | 2007-03-29 |
| 1053324186 | Tommy Lamar Jackson | Physician Assistant | 1802 Yakima Ave Ste 204, Tacoma, WA 98405-5304 | 2006-08-13 |
| 1396763140 | Jerry John Papson | Physician Assistant | 1812 South J St, Suite 210, Tacoma, WA 98405-4964 | 2006-07-18 |
| 1215996798 | Jill Tricia Eggersknight | Physician Assistant | Orthopedic Surgery Service, Attn: Mchj-sop, Tacoma, WA 98431-0001 | 2006-03-22 |
| 1588127062 | Sung Ho Kim | Physician Assistant | 1724 W Union Ave Ste 100, Tacoma, WA 98405-2099 | 2019-04-10 |
| 1215407770 | Monica Huang | Physician Assistant | 1724 W Union Ave Ste 100, Tacoma, WA 98405-2099 | 2018-11-27 |
| 1154803237 | Limary Gonzalez | Physician Assistant | 1717 S J St, Tacoma, WA 98405-4933 | 2018-09-05 |
| 1942725072 | Breanna Lynn Polk | Physician Assistant | 1724 W Union Ave, Tacoma, WA 98405-2099 | 2017-08-09 |
| 1104354190 | Samantha Sokol | Physician Assistant | 1717 S J St, Tacoma, WA 98405-4933 | 2017-06-02 |
| 1548662752 | Tomasz Gondek | Physician Assistant | 209 Martin Luther King Jr Way, Tacoma, WA 98405-4265 | 2014-09-18 |
| Find all providers in TACOMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.