Provider Demographics
NPI:1942223292
Name:PATCH, DOUGLAS ARTHUR (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ARTHUR
Last Name:PATCH
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 1:1427 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3807
Mailing Address - Country:US
Mailing Address - Phone:425-462-9800
Mailing Address - Fax:425-454-9143
Practice Address - Street 1:1427 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3807
Practice Address - Country:US
Practice Address - Phone:425-462-9800
Practice Address - Fax:425-454-9143
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA75726207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8960770Medicare PIN
F24420Medicare UPIN