Provider Demographics
NPI:1649285198
Name:HOUTZ, JANE M (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:M
Last Name:HOUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 GRIFFIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2373
Mailing Address - Country:US
Mailing Address - Phone:360-825-8900
Mailing Address - Fax:360-825-8904
Practice Address - Street 1:2820 GRIFFIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:360-825-8900
Practice Address - Fax:360-825-8904
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110198359OtherRAILROAD
WA133810OtherL & I
WA8249765Medicaid
WA8929992OtherCRIME VICTIMS
WA8929992OtherCRIME VICTIMS
WAGAB12804Medicare PIN