Provider Demographics
NPI:1174800593
Name:KEVIN DOOMS MD PLLC
Entity type:Organization
Organization Name:KEVIN DOOMS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:DOOMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-455-8391
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:SUITE 1730
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:206-223-9322
Mailing Address - Fax:425-455-8391
Practice Address - Street 1:751 NE BLAKELY DR
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:206-223-9322
Practice Address - Fax:425-455-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-140-833261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1548226285OtherTYPE-1 NPI
WA1548226285OtherTYPE-1 NPI