=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780782904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIC O RASMUSSEN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 04/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 POINT FOSDICK DR NW #219
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-851-7733
-----------------------------------------------------
Fax | 253-851-8060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 POINT FOSDICK DR NW #219
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-851-7733
-----------------------------------------------------
Fax | 253-851-8060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. ERIC O RASMUSSEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 253-851-7733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | MD00019650
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------