Provider Demographics
NPI:1497978365
Name:PINKLEY, DOUGLAS L (LPO, CPO)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:L
Last Name:PINKLEY
Suffix:
Gender:M
Credentials:LPO, CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5577
Mailing Address - Country:US
Mailing Address - Phone:206-328-4276
Mailing Address - Fax:206-328-1037
Practice Address - Street 1:411 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5577
Practice Address - Country:US
Practice Address - Phone:206-328-4276
Practice Address - Fax:206-328-1037
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS000003781744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9015561Medicaid
WA9015561Medicaid
WA0285850002Medicare ID - Type UnspecifiedPROV NUMBER - LOCATION 2