Healthcare Provider Details

I. General information

NPI: 1104868462
Provider Name (Legal Business Name): AXIS NEPHROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 S YAKIMA AVE SUITE 107
TACOMA WA
98405
US

IV. Provider business mailing address

1708 S YAKIMA AVE SUITE 107
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-5881
  • Fax: 253-383-0161
Mailing address:
  • Phone: 253-272-5881
  • Fax: 253-383-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00040610
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID W DEMPSTER
Title or Position: CREDENTIALING- BILLING SPECIALIST
Credential:
Phone: 253-272-5881