Provider Demographics
NPI:1932291127
Name:PORTELANCE, DOUGLAS A (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:PORTELANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 110456
Mailing Address - Street 2:MS 13739
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-0456
Mailing Address - Country:US
Mailing Address - Phone:425-899-6700
Mailing Address - Fax:425-899-6701
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:STE 310
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-6700
Practice Address - Fax:425-899-6701
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA145685OtherLABOR & INDUSTRY
WA0552POOtherREGENCE HEALTH
WA0552POOtherREGENCE HEALTH
WA145685OtherLABOR & INDUSTRY