Provider Demographics
NPI:1881729481
Name:SUGUITAN, DEMETRIO BANAGLORIOSO JR (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIO
Middle Name:BANAGLORIOSO
Last Name:SUGUITAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3925 159TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6309
Mailing Address - Country:US
Mailing Address - Phone:425-216-0550
Mailing Address - Fax:425-216-0551
Practice Address - Street 1:3925 159TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6309
Practice Address - Country:US
Practice Address - Phone:425-216-0550
Practice Address - Fax:425-216-0551
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2017-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60573558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH45434Medicare UPIN