Provider Demographics
NPI:1245288927
Name:SOULIERE, CHARLES R JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:SOULIERE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-627-6731
Mailing Address - Fax:253-627-1064
Practice Address - Street 1:700 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5115
Practice Address - Country:US
Practice Address - Phone:360-923-7000
Practice Address - Fax:360-923-7089
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00029182207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223169OtherSTATE L&I
WA1099951Medicaid
WA208378OtherSTATE L&I
WAP00313076OtherMEDICARE RAILROAD
WA8941430OtherSTATE CRIME VICTIMS
WA0208377OtherSTATE L&I
WAG8860213Medicare PIN
WAP00313076OtherMEDICARE RAILROAD
WAG8860194Medicare PIN