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NPI Code Detail

MEDICARE: DAVID W AGNOR PHD PC

MEDICARE: DAVID W AGNOR PHD PC
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
1103TC0700XClinical PsychologistPY00001983WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518929470
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID W AGNOR PHD PC
Provider Business Mailing Address
First Line : 9340 NE 76TH ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-3721
Country : US
Telephone Number : 360-253-4912
Fax Number : 360-253-5170
Provider Business Practice Location Address
First Line : 9340 NE 76TH ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-3721
Country : US
Telephone Number : 360-253-4912
Fax Number : 360-253-5170
Authorized Official
Title or Position : EXECUTIVE DIRECTOR OWNER
Name : DR. DAVID W AGNOR
Credential : PHD
Telephone Number : 360-253-4912
Provider Enumeration Date : 04/05/2006
Last Update Date : 01/23/2008

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Directions to “DAVID W AGNOR PHD PC ” Practice Location

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