1487791612 NPI number — DR. PERRY HAYWOOD GUYTON III D.C.

Table of content: DR. PERRY HAYWOOD GUYTON III D.C. (NPI 1487791612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487791612 NPI number — DR. PERRY HAYWOOD GUYTON III D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUYTON
Provider First Name:
PERRY
Provider Middle Name:
HAYWOOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.C.
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:
1487791612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2816 SE 138TH LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-6612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-798-9883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 SE 131ST AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-4031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-944-0050
Provider Business Practice Location Address Fax Number:
360-885-1212
Provider Enumeration Date:
01/30/2007

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: 111N00000X , with the licence number:  CH00033848 , 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)





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