Provider Demographics
NPI:1134158694
Name:RICH, DAVID BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:RICH
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 1:202 N DIVISION ST
Mailing Address - Street 2:STE. 405, PLAZA 2
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4939
Mailing Address - Country:US
Mailing Address - Phone:253-939-3604
Mailing Address - Fax:253-735-4167
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:STE. 405, PLAZA 2
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-939-3604
Practice Address - Fax:253-735-4167
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00279456OtherRAILROAD MEDICARE
WA8441073Medicaid
WA8856749Medicare ID - Type Unspecified
WA8441073Medicaid
WAP00279456OtherRAILROAD MEDICARE