Provider Demographics
NPI:1881878163
Name:DIANE L COMBS MD PS
Entity type:Organization
Organization Name:DIANE L COMBS MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-851-3992
Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-851-3992
Mailing Address - Fax:253-851-4310
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:SUITE 208
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-3992
Practice Address - Fax:253-851-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602343242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1004522Medicaid
WA0150158OtherLABOR & INDUSTRIES
WAA08362Medicare UPIN
WA1004522Medicaid