Provider Demographics
NPI:1790835981
Name:PATEL, RAJU (DO)
Entity Type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:STE B5003
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1805
Mailing Address - Country:US
Mailing Address - Phone:253-572-4900
Mailing Address - Fax:253-572-4645
Practice Address - Street 1:1901 S UNION AVE BLDG B
Practice Address - Street 2:SUITE 3001
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-572-4900
Practice Address - Fax:253-572-4645
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP0001797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8313397Medicaid
WA4788PAOtherREGENCE
WA160350OtherDEPARTMENT OF L&I
WA1800PAOtherREGENCE
WA1708PAOtherREGENCE
WA1300PAOtherREGENCE
WA1802PAOtherREGENCE
WAF68991Medicare UPIN
WA1800PAOtherREGENCE