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General NPI Number Information
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NPI Number | 1437530185
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Entity Type | Organization
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Legal Business Name | MAN ALIVE, LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 9430 NE VANCOUVER MALL DR
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City | VANCOUVER
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State | WA
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Zip | 98662-6172
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Country | US
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Telephone | 360-253-6947
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Fax |
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Provider Business Mailing Address
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Address Line | 9430 NE VANCOUVER MALL DR
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City | VANCOUVER
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State | WA
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Zip | 98662-6172
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Country | US
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Telephone | 360-984-5806
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Fax | 360-984-5994
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Authorized Official
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Title or Position | OWNER
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Name | DEAN BARRUS
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Credential |
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Telephone | 360-984-5806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00043839
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License Number State | WA
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