Provider Demographics
NPI:1083853253
Name:DANIEL T. DUGAW,D.O., P.S.
Entity Type:Organization
Organization Name:DANIEL T. DUGAW,D.O., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUGAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-352-8781
Mailing Address - Street 1:405 BLACK HILLS LN SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8661
Mailing Address - Country:US
Mailing Address - Phone:360-352-8781
Mailing Address - Fax:360-352-8837
Practice Address - Street 1:405 BLACK HILLS LN SW
Practice Address - Street 2:SUITE E
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8661
Practice Address - Country:US
Practice Address - Phone:360-352-8781
Practice Address - Fax:360-352-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235803Medicaid
WA35974OtherLABOR & INDUSTRIES