Provider Demographics
NPI:1093044513
Name:DOUGLAS H LOUIE MD PHD PS
Entity Type:Organization
Organization Name:DOUGLAS H LOUIE MD PHD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-537-1562
Mailing Address - Street 1:12157 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5124
Mailing Address - Country:US
Mailing Address - Phone:253-537-1562
Mailing Address - Fax:
Practice Address - Street 1:12157 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5124
Practice Address - Country:US
Practice Address - Phone:253-537-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1111756Medicaid
WAE98233OtherUPIN
WAE98233OtherUPIN
WAAB18018Medicare PIN