Provider Demographics
NPI:1962448894
Name:DUFAULT, ANNA T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:T
Last Name:DUFAULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3003 TIETON DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3679
Mailing Address - Country:US
Mailing Address - Phone:509-453-7109
Mailing Address - Fax:509-453-3659
Practice Address - Street 1:3003 TIETON DR
Practice Address - Street 2:SUITE 240
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3679
Practice Address - Country:US
Practice Address - Phone:509-453-7109
Practice Address - Fax:509-453-3659
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046611207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457210Medicaid
WAGI62008Medicare UPIN