Provider Demographics
NPI:1669493227
Name:EMMANS, PAUL E III (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:EMMANS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:509-972-1818
Mailing Address - Fax:509-225-2706
Practice Address - Street 1:311 S 72ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1661
Practice Address - Country:US
Practice Address - Phone:509-972-1818
Practice Address - Fax:509-225-2706
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB38059Medicare Oscar/Certification
WAG8863840Medicare PIN
WAP00889474OtherRAILROAD MEDICARE
WA8349318Medicaid
WA0217565OtherLABOR & INDUSTRIES