Provider Demographics
NPI:1629610050
Name:MENON, DRUCE V (PA-C)
Entity type:Individual
Prefix:
First Name:DRUCE
Middle Name:V
Last Name:MENON
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 1:503 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98421-1343
Mailing Address - Country:US
Mailing Address - Phone:253-881-7001
Mailing Address - Fax:253-881-7002
Practice Address - Street 1:503 E 26TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-1343
Practice Address - Country:US
Practice Address - Phone:253-881-7001
Practice Address - Fax:253-881-7002
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57173363A00000X
NY026144363A00000X
WAPA61267486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant