MEDICARE: DR. EDWARD I. DAGHER 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	208100000X	Physical Medicine & Rehabilitation Physician	MD60025245	WA
2	2083X0100X	Occupational Medicine Physician	MD60025245	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265158	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1487732145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD I. DAGHER MD

Provider Business Mailing Address
First Line	:	PO BOX 13316
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98508-3316
Country	:	US
Telephone Number	:	360-878-8862
Fax Number	:	360-878-8619

Provider Business Practice Location Address
First Line	:	1822 BLACK LAKE BLVD SW
Second Line	:	SUITE 102
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5628
Country	:	US
Telephone Number	:	360-877-8862
Fax Number	:	360-878-8619

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/24/2013

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