Provider Demographics
NPI:1811182165
Name:DORIS A PAGE, M.D.
Entity type:Organization
Organization Name:DORIS A PAGE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-572-9923
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:SUITE B3003
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-572-9923
Mailing Address - Fax:253-572-8224
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:SUITE B3003
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-572-9923
Practice Address - Fax:253-572-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9634254Medicaid
WA1054956Medicaid
WA1891895223OtherNPI
WA1054956Medicaid
WA9634254Medicaid