Healthcare Provider Details

I. General information

NPI: 1992881510
Provider Name (Legal Business Name): DEBORAH J AYARS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE #B1010
TACOMA WA
98405
US

IV. Provider business mailing address

1901 S UNION AVE #B1010
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-5971
  • Fax: 253-572-5987
Mailing address:
  • Phone: 253-572-5971
  • Fax: 253-572-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD00026169
License Number StateWA

VIII. Authorized Official

Name: SHANNA R DUPEA
Title or Position: CREDENTIALING
Credential:
Phone: 253-572-5971