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General NPI Number Information
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NPI Number | 1215111786
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Entity Type | Individual
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Provider Name | MICHAEL DAVID PERREAULT M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 9040 A JACKSON AVE MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-CLL
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City | TACOMA
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State | WA
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Zip | 98431-1101
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Country | US
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Telephone | 253-968-1250
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Fax | 253-968-2550
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Provider Business Mailing Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-2252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10855
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License Number State | ND
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