Provider Demographics
NPI:1033441415
Name:DURIAS, JOEL M (RPSGT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:M
Last Name:DURIAS
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S TOBIN ST
Mailing Address - Street 2:# 205
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5324
Mailing Address - Country:US
Mailing Address - Phone:425-738-0828
Mailing Address - Fax:425-738-4530
Practice Address - Street 1:95 S TOBIN ST
Practice Address - Street 2:# 205
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5324
Practice Address - Country:US
Practice Address - Phone:425-738-0828
Practice Address - Fax:425-738-4530
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602781923291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory