Provider Demographics
NPI:1275583833
Name:BIRKEBAK, DOUGLAS J (PA-C)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:BIRKEBAK
Suffix:
Gender:M
Credentials:PA-C
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 94391
Mailing Address - Street 2:MS/LB 310054
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6691
Mailing Address - Country:US
Mailing Address - Phone:888-579-7777
Mailing Address - Fax:
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-431-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002010363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA29624UOtherREGENCE BLUE SHIELD PIN
WA8398158Medicaid
WA9622BIOtherREGENCE BLUE SHIELD PIN
WA9622BIOtherREGENCE BLUE SHIELD PIN
S51677Medicare UPIN
WAG8906666Medicare PIN