Provider Demographics
NPI:1790748549
Name:DEVRIES, DONALD FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:FRED
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1011 MAIN AVE E
Mailing Address - Street 2:STE 302
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6775
Mailing Address - Country:US
Mailing Address - Phone:253-841-2471
Mailing Address - Fax:253-841-2472
Practice Address - Street 1:1011 E MAIN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6775
Practice Address - Country:US
Practice Address - Phone:253-841-2471
Practice Address - Fax:253-841-2472
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-07-22
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024699207RE0101X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1029032Medicaid
WA0014041OtherLABOR & INDUSTRIES
110187011OtherRAILROAD MEDICARE
GAB09020Medicare PIN
A16431Medicare UPIN