Provider Demographics
NPI:1437122579
Name:ROUSE, MURRAY EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:EUGENE
Last Name:ROUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 31ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3723
Mailing Address - Country:US
Mailing Address - Phone:253-445-7100
Mailing Address - Fax:
Practice Address - Street 1:611 31ST AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3723
Practice Address - Country:US
Practice Address - Phone:253-445-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8121477Medicaid
WA080182162Medicare PIN
WAE57802Medicare UPIN
WAG001050823Medicare PIN
WAGAB39597Medicare PIN
WAG8871871Medicare PIN
WAGAB39594Medicare PIN