Healthcare Provider Details

I. General information

NPI: 1497140206
Provider Name (Legal Business Name): ANGUS AGNEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 5215
TACOMA WA
98415-0215
US

V. Phone/Fax

Practice location:
  • Phone: 253-402-1000
  • Fax:
Mailing address:
  • Phone: 253-403-8327
  • Fax: 253-403-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60835858
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: