Provider Demographics
NPI:1548618432
Name:AGUIRRE, DOUG EDUARDO (PA)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:EDUARDO
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3926
Mailing Address - Country:US
Mailing Address - Phone:253-441-4742
Mailing Address - Fax:253-441-8680
Practice Address - Street 1:1202 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3926
Practice Address - Country:US
Practice Address - Phone:253-441-4742
Practice Address - Fax:253-441-8680
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60810745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60810745OtherWASHINGTON STATE PHYSICIAN ASSISTANT LICENSE