Healthcare Provider Details

I. General information

NPI: 1871586776
Provider Name (Legal Business Name): EDWARD JOSEPH LEDOUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MARTIN LUTHER KING JR WAY STE 401
TACOMA WA
98405-4252
US

IV. Provider business mailing address

316 MARTIN LUTHER KING JR WAY STE 401
TACOMA WA
98405-4252
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-5140
  • Fax: 253-272-0419
Mailing address:
  • Phone: 253-572-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25328
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25328
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25328
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: