Healthcare Provider Details

I. General information

NPI: 1992865869
Provider Name (Legal Business Name): DEREK GEORGE DOMBROSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 100
OLYMPIA WA
98506-5117
US

IV. Provider business mailing address

3382 WAIALAE AVE
HONOLULU HI
96816-2637
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-4211
  • Fax: 360-493-0407
Mailing address:
  • Phone: 808-548-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD61552497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: