Provider Demographics
NPI:1598785651
Name:PAUL A. ZAVERUHA, MD PS, INC
Entity Type:Organization
Organization Name:PAUL A. ZAVERUHA, MD PS, INC
Other - Org Name:PAUL A. ZAVERUHA, MD PS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAVERUHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-678-6433
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:101 NE BIRCH ST
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-1080
Mailing Address - Country:US
Mailing Address - Phone:360-678-6433
Mailing Address - Fax:360-678-6812
Practice Address - Street 1:101 NE BIRCH STREET
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239
Practice Address - Country:US
Practice Address - Phone:360-678-6433
Practice Address - Fax:360-678-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601799900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA378259003OtherGROUP HEALTH ID NUMBER
911826264 98239 A001OtherTRICARE
WA7088347Medicaid
WA911826264 SU5491OtherREGENCE BLUESHIELD
WA7088347Medicaid