Provider Demographics
NPI:1134188253
Name:DUTKY, PAUL ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARTHUR
Last Name:DUTKY
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 1:3914 NW FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1341
Mailing Address - Country:US
Mailing Address - Phone:360-479-2683
Mailing Address - Fax:360-479-2683
Practice Address - Street 1:3914 NW FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1341
Practice Address - Country:US
Practice Address - Phone:360-479-2683
Practice Address - Fax:360-479-2683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024370207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06422Medicare UPIN
WAAB20928Medicare ID - Type Unspecified