Provider Demographics
NPI:1669463519
Name:PRESTA, DOUGLAS DARREN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DARREN
Last Name:PRESTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 TALBOT RD S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6226
Mailing Address - Country:US
Mailing Address - Phone:425-336-4442
Mailing Address - Fax:425-271-1368
Practice Address - Street 1:4361 TALBOT RD S
Practice Address - Street 2:SUITE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6226
Practice Address - Country:US
Practice Address - Phone:425-336-4442
Practice Address - Fax:425-271-1368
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0196005213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0293820001OtherCIGNA MEDICARE
WA1597PROtherREGENCE
WA0056910OtherWORKERS COMP GRP #
WAVA5229OtherREGENCE GROUP #
WA8274391Medicaid
WA0196005OtherWORKERS COMP
WA0196005OtherWORKERS COMP
WA0293820001OtherCIGNA MEDICARE