Provider Demographics
NPI:1245217256
Name:DEBUSSCHERE, PAUL E (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:DEBUSSCHERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1033 REGENTS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6045
Mailing Address - Country:US
Mailing Address - Phone:253-564-1115
Mailing Address - Fax:253-565-4552
Practice Address - Street 1:1033 REGENTS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6045
Practice Address - Country:US
Practice Address - Phone:253-564-1115
Practice Address - Fax:253-565-4552
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00035432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8230740OtherDSHS NUMBER
WA501834Medicare UPIN