Provider Demographics
NPI:1891895223
Name:PAGE, DORIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:A
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S UNION AVE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1907
Mailing Address - Country:US
Mailing Address - Phone:253-572-9923
Mailing Address - Fax:253-572-8224
Practice Address - Street 1:1310 S UNION AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1907
Practice Address - Country:US
Practice Address - Phone:253-572-9923
Practice Address - Fax:253-572-8224
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021664OtherPROVIDER ONE
WA7139744Medicaid
WAGAB18185OtherMEDICARE PTAN
WA010018581OtherRR MEDICARE PTAN
WA7139744Medicaid
D24764Medicare UPIN