Provider Demographics
NPI:1841361003
Name:DOUGLAS, MEGAN (LMP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 6TH AVE STE 200A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5419
Mailing Address - Country:US
Mailing Address - Phone:253-507-7121
Mailing Address - Fax:253-267-1607
Practice Address - Street 1:3518 6TH AVE STE 200A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5419
Practice Address - Country:US
Practice Address - Phone:253-507-7121
Practice Address - Fax:253-267-1607
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP10001388174400000X
WARC00046696174400000X
WAMA00018906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194713OtherDOLI CLINIC ID
WA0177904OtherDOLI