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General NPI Number Information
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NPI Number | 1750482915
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Entity Type | Organization
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Legal Business Name | ENUMCLAW RADIOLOGISTS PLLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 1455 BATTERSBY AVE
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City | ENUMCLAW
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State | WA
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Zip | 98022-3634
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Country | US
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Telephone | 916-965-7938
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Fax |
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Provider Business Mailing Address
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Address Line | 8642 AMBER OAKS CT
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City | FAIR OAKS
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State | CA
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Zip | 95628-2978
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DAVID RICE
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Credential | MD
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Telephone | 916-965-7938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00031208
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License Number State | WA
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