Healthcare Provider Details

I. General information

NPI: 1295873578
Provider Name (Legal Business Name): DAN E RANNIGER MD PS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13210 SE 240TH ST A6
KENT WA
98042-5182
US

IV. Provider business mailing address

13210 SE 240TH ST A6
KENT WA
98042-5182
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-9570
  • Fax: 253-854-3478
Mailing address:
  • Phone: 253-854-9570
  • Fax: 253-854-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD00005641
License Number StateWA

VIII. Authorized Official

Name: DR. DAN E. RANNIGER
Title or Position: OWNER
Credential: M.D.
Phone: 253-854-9570