Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | WAPO00000717 | WA |
Y | 222Z00000X | Podiatrist | WAPO00000717 | WA |
N | 213ES0103X | Foot & Ankle Surgery | PO00000717 | WA |
NPI | 1083719876 |
---|---|
Provider Name | Dr. Michael Dale Dujela |
First Address | Tumwater, WA 98512-6357 |
Second Address | Centralia, WA 98531-9071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0166528 | STECK L&I (01) | WA |
157969 | L&I (01) | WA |
2869DU | REGENCE RIDER (01) | WA |
480033742 | MEDICARE RR (01) | WA |
8299265 | (05) | WA |
8377749 | (05) | WA |
9110DU | STECK REGENCE (01) | WA |
U188195 | (02) | WA |