Provider Demographics
NPI:1487732145
Name:DAGHER, EDWARD I (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:I
Last Name:DAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13316
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-3316
Mailing Address - Country:US
Mailing Address - Phone:360-878-8862
Mailing Address - Fax:360-878-8619
Practice Address - Street 1:1822 BLACK LAKE BLVD SW
Practice Address - Street 2:SUITE 102
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5628
Practice Address - Country:US
Practice Address - Phone:360-877-8862
Practice Address - Fax:360-878-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60025245208100000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA265158OtherSTATE L&I
WA265158OtherSTATE L&I