Healthcare Provider Details

I. General information

NPI: 1932547213
Provider Name (Legal Business Name): MIDHUNA MARY PAPAZIAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIDHUNA MARY WILLIAM MD

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 40TH AVE
YAKIMA WA
98908-4311
US

IV. Provider business mailing address

PO BOX 9787
YAKIMA WA
98909-0787
US

V. Phone/Fax

Practice location:
  • Phone: 509-966-9480
  • Fax: 509-225-2704
Mailing address:
  • Phone: 509-575-8255
  • Fax: 509-577-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.MD.60651023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: