Healthcare Provider Details

I. General information

NPI: 1659013605
Provider Name (Legal Business Name): RONALD SPENCER CUA TE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 M.L.K. JR WAY
TACOMA WA
98405
US

IV. Provider business mailing address

663 E KIRBY ST APT 38
DETROIT MI
48202-4187
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1000
  • Fax:
Mailing address:
  • Phone: 847-890-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO.OP.70090786
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5101028632
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: