Provider Demographics
NPI:1285668822
Name:DO, SON T (MD)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:T
Last Name:DO
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 1:2415 NE 134TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3025
Mailing Address - Country:US
Mailing Address - Phone:360-576-5060
Mailing Address - Fax:
Practice Address - Street 1:2415 NE 134TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3025
Practice Address - Country:US
Practice Address - Phone:360-576-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042129207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH97048Medicare UPIN
WA8856934Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NMBR