MEDICARE: ARLENE E. DORROUGH PA-C

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	363AM0700X	Medical Physician Assistant	PA10004920	WA

General Provider Information

NPI Number	:	1619040912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLENE E. DORROUGH PA-C

Provider Business Mailing Address
First Line	:	4824 S 170TH ST
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98188-3256
Country	:	US
Telephone Number	:	206-817-2349
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ANDOVER PARK E
Second Line	:	SUITE 8
City	:	TUKWILA
State	:	WA
Zip	:	98188-2938
Country	:	US
Telephone Number	:	206-575-3136
Fax Number	:	206-575-7657

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	10/11/2016

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