MEDICARE: CHRISTINE TAT DOUGLAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD61389754	WA

General Provider Information

NPI Number	:	1447677315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE TAT DOUGLAS MD

Provider Business Mailing Address
First Line	:	3209 S 23RD ST STE 170
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-1621
Country	:	US
Telephone Number	:	253-292-5107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 S 23RD ST STE 170
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-1621
Country	:	US
Telephone Number	:	253-292-5107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/24/2026

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