Healthcare Provider Details

I. General information

NPI: 1245217256
Provider Name (Legal Business Name): PAUL E DEBUSSCHERE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 REGENTS BLVD SUITE 102
FIRCREST WA
98466-6045
US

IV. Provider business mailing address

1033 REGENTS BLVD SUITE 102
FIRCREST WA
98466-6045
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-1115
  • Fax: 253-565-4552
Mailing address:
  • Phone: 253-564-1115
  • Fax: 253-565-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00035432
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: