Provider Demographics
NPI:1659014843
Name:KOUKOL, DENNIS CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:CHARLES
Last Name:KOUKOL
Suffix:
Gender:M
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:PO BOX 9303
Mailing Address - Street 2:MS 45550
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507
Mailing Address - Country:US
Mailing Address - Phone:800-562-6074
Mailing Address - Fax:833-656-1248
Practice Address - Street 1:6737 CAPITOL BLVD SW BLDG 2
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5581
Practice Address - Country:US
Practice Address - Phone:800-562-6074
Practice Address - Fax:833-656-1248
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00015692207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease