Provider Demographics
NPI:1881638112
Name:ROSSI, DOUGLAS C (PA-C)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:ROSSI
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 1:1802 YAKIMA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5303
Mailing Address - Country:US
Mailing Address - Phone:253-272-7777
Mailing Address - Fax:253-761-1040
Practice Address - Street 1:1802 YAKIMA AVE STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5303
Practice Address - Country:US
Practice Address - Phone:253-272-7777
Practice Address - Fax:253-761-1040
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001842363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8901379OtherCRIME VICTIMS
WAP00229060OtherMEDICARE RAILROAD
WA1046035Medicaid
WA8423030Medicaid
WA196341OtherSTATE L&I
WA8901379OtherCRIME VICTIMS
WA8853872Medicare ID - Type Unspecified