1366408353 NPI number — DR. PAUL S DARBY MD

Table of content: DR. PAUL S DARBY MD (NPI 1366408353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366408353 NPI number — DR. PAUL S DARBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARBY
Provider First Name:
PAUL
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366408353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MD PHD SERVICES, PLLC
Provider Second Line Business Mailing Address:
1901 65TH AVENUE WEST, SUITE 250
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-480-5884
Provider Business Mailing Address Fax Number:
425-728-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PAUL S. DARBY, MD, PHD, P.S.
Provider Second Line Business Practice Location Address:
1901 65TH AVENUE WEST, SUITE 250
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-480-5884
Provider Business Practice Location Address Fax Number:
425-728-5753
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  MD00040014 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X , with the licence number: MD00040014 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07-07402 . This is a "MEDICAL REVIEW OFFICER CERTIFICATION COUNCIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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