Provider Demographics
NPI:1609153766
Name:DUTTON VETERINARY MEDICINE PLLC
Entity Type:Organization
Organization Name:DUTTON VETERINARY MEDICINE PLLC
Other - Org Name:MEDICAL LAKE VETERINARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VETERINARIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:509-299-3675
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:212 EAST LAKE STREET
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-0156
Mailing Address - Country:US
Mailing Address - Phone:509-299-3675
Mailing Address - Fax:509-299-3279
Practice Address - Street 1:212 EAST LAKE STREET
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022
Practice Address - Country:US
Practice Address - Phone:509-299-3675
Practice Address - Fax:509-299-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT60108256284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital