Provider Demographics
NPI:1578281614
Name:SRA, SIMRANJIT SINGH (MBBS, MPH, PA-S)
Entity Type:Individual
Prefix:
First Name:SIMRANJIT
Middle Name:SINGH
Last Name:SRA
Suffix:
Gender:M
Credentials:MBBS, MPH, PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2928
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2928
Mailing Address - Country:US
Mailing Address - Phone:425-207-5155
Mailing Address - Fax:
Practice Address - Street 1:1350 MARVIN RD NE STE D
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3877
Practice Address - Country:US
Practice Address - Phone:888-227-3312
Practice Address - Fax:360-413-6509
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61479373363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2265952Medicaid