Provider Demographics
NPI:1477581817
Name:DATLOFF, JOEL H (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:H
Last Name:DATLOFF
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 1:8614 E MILL PLAIN BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2059
Mailing Address - Country:US
Mailing Address - Phone:360-254-5267
Mailing Address - Fax:360-254-6089
Practice Address - Street 1:8614 E MILL PLAIN BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2059
Practice Address - Country:US
Practice Address - Phone:360-254-5267
Practice Address - Fax:360-254-6089
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023811207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1027416Medicaid
0615388Medicare ID - Type Unspecified
WA1027416Medicaid