Provider Demographics
NPI:1265655070
Name:BADZIK, DOUGLAS ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALLAN
Last Name:BADZIK
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 1:8919 119TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-7976
Mailing Address - Country:US
Mailing Address - Phone:253-968-4479
Mailing Address - Fax:
Practice Address - Street 1:8919 119TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7976
Practice Address - Country:US
Practice Address - Phone:253-968-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine