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NPI Code Detail

MEDICARE: DOUGLAS BRENT RUTAN DPM

MEDICARE: DOUGLAS BRENT RUTAN DPM
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
1213E00000XPodiatristP0515WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1164425100000OTHERPREMARA
2480014538OTHERRR MCR
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4050259000OTHERBC

General Provider Information

NPI Number : 1821081613
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS BRENT RUTAN DPM
Provider Business Mailing Address
First Line : 100 E 33RD ST STE 206
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-2776
Country : US
Telephone Number : 360-695-1334
Fax Number : 360-992-1159
Provider Business Practice Location Address
First Line : 100 E 33RD ST STE 206
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-2776
Country : US
Telephone Number : 360-695-1334
Fax Number : 360-992-1159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 06/29/2021

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Directions to “ DOUGLAS BRENT RUTAN DPM” Practice Location

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