Provider Demographics
NPI:1972903458
Name:RODGERS, DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RODGERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 S J ST, STE 120
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4965
Mailing Address - Country:US
Mailing Address - Phone:253-425-2200
Mailing Address - Fax:360-744-6270
Practice Address - Street 1:1818 S J ST, STE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4965
Practice Address - Country:US
Practice Address - Phone:253-425-2200
Practice Address - Fax:360-744-6270
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60080597164W00000X
1145181171000000X
WAPA60815222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2121865Medicaid