Provider Demographics
NPI:1750385738
Name:NEWPORT, DOUGLAS ROBERT (CRNA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:NEWPORT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1514 NE 103RD CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4356
Mailing Address - Country:US
Mailing Address - Phone:360-253-5135
Mailing Address - Fax:
Practice Address - Street 1:400 NE MOTHER JOSEPH PL.
Practice Address - Street 2:SW WASHINGTON MED CENTER,FBC-ANESTHESIA
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98668-9989
Practice Address - Country:US
Practice Address - Phone:360-514-4004
Practice Address - Fax:360-514-4052
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004554367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32072Medicare ID - Type UnspecifiedHOSPITAL EMPLOYED- SWMC