Healthcare Provider Details

I. General information

NPI: 1841322567
Provider Name (Legal Business Name): CEDAR MEDICAL SPECIALTIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S CEDAR ST SUITE 300
TACOMA WA
98405-2318
US

IV. Provider business mailing address

2202 S CEDAR ST SUITE 300
TACOMA WA
98405-2318
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-2900
  • Fax: 253-627-2941
Mailing address:
  • Phone: 253-627-2900
  • Fax: 253-627-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID V PRATT
Title or Position: OWNER
Credential: MD
Phone: 253-627-2900