Provider Demographics
NPI:1740372861
Name:MUFF, NICHOLAS S (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:MUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 977
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239
Mailing Address - Country:US
Mailing Address - Phone:360-678-4071
Mailing Address - Fax:360-678-6014
Practice Address - Street 1:260 E ONTARIO AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3508
Practice Address - Country:US
Practice Address - Phone:949-490-4820
Practice Address - Fax:949-490-4819
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG255442085R0001X
WAMD00015015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05660OtherREGENCE BS
WA13895001OtherGROUP HEALTH
WA1160381Medicaid
WA13895001OtherGROUP HEALTH
WA001100142Medicare ID - Type Unspecified