Healthcare Provider Details

I. General information

NPI: 1881636629
Provider Name (Legal Business Name): JOSEPHINE ELIZABETH DREW M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 S 5TH ST SUITE 113
RIDGEFIELD WA
98642-3421
US

IV. Provider business mailing address

8507 S 5TH ST SUITE 113
RIDGEFIELD WA
98642-3421
US

V. Phone/Fax

Practice location:
  • Phone: 360-887-9494
  • Fax: 360-887-9498
Mailing address:
  • Phone: 360-887-9494
  • Fax: 360-887-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD35299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: