Provider Demographics
NPI:1902842867
Name:KURATA, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:KURATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368
Mailing Address - Country:US
Mailing Address - Phone:907-442-7148
Mailing Address - Fax:
Practice Address - Street 1:19045 HWY 305
Practice Address - Street 2:SUITE 180
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-779-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5713207Q00000X
WA00018683207Q00000X
WAMD00018683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1745405Medicaid
WA8866428OtherMEDICARE PIN
AKMD5135Medicaid
WA8866427OtherMEDICARE PIN
WA1745405Medicaid
AK8EC224Medicare ID - Type UnspecifiedMANIILAQ
WA8866204Medicare PIN