Provider Demographics
NPI:1982697322
Name:OKAMOTO, DEEMS (MD)
Entity Type:Individual
Prefix:
First Name:DEEMS
Middle Name:
Last Name:OKAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14731 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6547
Mailing Address - Country:US
Mailing Address - Phone:206-365-0220
Mailing Address - Fax:206-365-6436
Practice Address - Street 1:14731 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6547
Practice Address - Country:US
Practice Address - Phone:206-365-0220
Practice Address - Fax:206-365-6436
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1070804Medicaid
WA1070804Medicaid
WA0997860001Medicare NSC
WAA55080Medicare UPIN