Healthcare Provider Details

I. General information

NPI: 1649285198
Provider Name (Legal Business Name): JANE M HOUTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 GRIFFIN AVE SUITE 204
ENUMCLAW WA
98022-2373
US

IV. Provider business mailing address

2820 GRIFFIN AVE SUITE 204
ENUMCLAW WA
98022-2373
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-8900
  • Fax: 360-825-8904
Mailing address:
  • Phone: 360-825-8900
  • Fax: 360-825-8904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00038185
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110198359
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerRAILROAD
# 2
Identifier133810
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I
# 3
Identifier8249765
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier8929992
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerCRIME VICTIMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: