Provider Demographics
NPI:1811541162
Name:DUSIN, ERIC RANDALL (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RANDALL
Last Name:DUSIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6907
Mailing Address - Country:US
Mailing Address - Phone:206-633-8100
Mailing Address - Fax:206-633-6107
Practice Address - Street 1:2409 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6907
Practice Address - Country:US
Practice Address - Phone:206-633-8100
Practice Address - Fax:206-633-6107
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007227363AS0400X
WAPA61110143363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical