Healthcare Provider Details

I. General information

NPI: 1487732145
Provider Name (Legal Business Name): EDWARD I. DAGHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 BLACK LAKE BLVD SW SUITE 102
OLYMPIA WA
98512-5628
US

IV. Provider business mailing address

PO BOX 13316
OLYMPIA WA
98508-3316
US

V. Phone/Fax

Practice location:
  • Phone: 360-877-8862
  • Fax: 360-878-8619
Mailing address:
  • Phone: 360-878-8862
  • Fax: 360-878-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60025245
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD60025245
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: