Provider Demographics
NPI:1437445855
Name:DIVIN, ALEXANDER A (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:A
Last Name:DIVIN
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 1:1717 S J ST #336
Mailing Address - Street 2:SOUTH PAVILLION, MS 01-30
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-426-6970
Mailing Address - Fax:253-426-6936
Practice Address - Street 1:1717 SOUTH J STREET SUITE 336
Practice Address - Street 2:SOUTH PAVILLION, MS 01-30
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-426-6970
Practice Address - Fax:253-426-6936
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60789297208M00000X
HIMD-17653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine