Healthcare Provider Details

I. General information

NPI: 1578011789
Provider Name (Legal Business Name): TYLER W. ZAUGG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 3RD ST STE 1
DAVENPORT WA
99122-5008
US

IV. Provider business mailing address

100 3RD ST STE 1
DAVENPORT WA
99122-5008
US

V. Phone/Fax

Practice location:
  • Phone: 509-725-7501
  • Fax:
Mailing address:
  • Phone: 509-725-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60700085
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: