Provider Demographics
NPI:1134127483
Name:HARROUN, DOUGLASS V (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLASS
Middle Name:V
Last Name:HARROUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23010
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-0010
Mailing Address - Country:US
Mailing Address - Phone:253-952-4554
Mailing Address - Fax:253-952-4774
Practice Address - Street 1:3950 SW 324TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2425
Practice Address - Country:US
Practice Address - Phone:253-874-5667
Practice Address - Fax:253-874-1229
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA29238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA7798OtherREGENCE BLUE SHILED
WA1077528Medicaid
WAP00091648OtherRAILROAD MEDICARE
WA0150564OtherLABOR & INDUSTRIES
WA50D1025809OtherCLIA
WAC16673Medicare UPIN
WAGAB27671Medicare ID - Type Unspecified