Provider Demographics
NPI:1053635102
Name:EDUARDO S CUEVAS MD PS
Entity Type:Organization
Organization Name:EDUARDO S CUEVAS MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-472-8389
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:STE A-114
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-472-8389
Mailing Address - Fax:253-472-4977
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:STE A-114
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-472-8389
Practice Address - Fax:253-472-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0058090OtherL&I
WA110177643OtherRAILROAD MEDICARE
WACU6119OtherREGENCE BLUE SHIELD
WA0058090OtherSEDGWICK CMS
WA192744400OtherUS DOL
WA4232211OtherAETNA
WA1103142Medicaid
WA1103142Medicaid
WA001002301Medicare PIN