Provider Demographics
NPI:1366408353
Name:DARBY, PAUL S (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:DARBY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MD PHD SERVICES, PLLC
Mailing Address - Street 2:1901 65TH AVENUE WEST, SUITE 250
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-480-5884
Mailing Address - Fax:425-728-5753
Practice Address - Street 1:PAUL S. DARBY, MD, PHD, P.S.
Practice Address - Street 2:1901 65TH AVENUE WEST, SUITE 250
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-480-5884
Practice Address - Fax:425-728-5753
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000400142083P0500X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07-07402OtherMEDICAL REVIEW OFFICER CERTIFICATION COUNCIL
WA159907OtherL&I PROVIDER NUMBER
WA0180163OtherL&I APPROVED EXAMINER NO.
IL07-07402OtherMEDICAL REVIEW OFFICER CERTIFICATION COUNCIL
WA2004792Medicaid