Provider Demographics
NPI:1609853993
Name:DYGERT, PAULA A (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:DYGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 S LONDON CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1655
Mailing Address - Country:US
Mailing Address - Phone:607-343-4675
Mailing Address - Fax:
Practice Address - Street 1:5901 N LIDGERWOOD ST STE 126
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-434-1990
Practice Address - Fax:509-340-8986
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60664470207R00000X
NY2305801207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571864Medicaid
NYJ900043194Medicare PIN
NYI15322Medicare UPIN