Provider Demographics
NPI:1366502601
Name:CARATAO, EFREN REBUSIT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:REBUSIT
Last Name:CARATAO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10413 SE 244TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4961
Mailing Address - Country:US
Mailing Address - Phone:253-852-2770
Mailing Address - Fax:253-852-6770
Practice Address - Street 1:10413 SE 244TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4961
Practice Address - Country:US
Practice Address - Phone:253-852-2770
Practice Address - Fax:253-852-6770
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028063208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABC2557835OtherDEA NUMBER
WAF09652Medicare UPIN