Active NPI
Douglas Stuart Dedo, PA-C, MCHS
- Physician Assistant
- Seattle, WA
National Provider Identifier
1174862890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.60331790
- Practice address
- 4800 Sand Point Way NE
Seattle, WA 98105-3901 - Phone
- (206) 987-2000
- NPI assigned
- Feb 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.60331790 | WA | Primary |
Addresses
Primary practice location
4800 Sand Point Way NE
Seattle, WA 98105-3901
Mailing address
8101 213TH PL NE
Redmond, WA 98053-2250
Phone (425) 681-5377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.60331790 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488326400000",
"number": "1174862890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8101 213TH PL NE",
"city": "REDMOND",
"state": "WA",
"postal_code": "980532250",
"telephone_number": "425-681-5377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 SAND POINT WAY NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981053901",
"telephone_number": "206-987-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDO",
"first_name": "DOUGLAS",
"middle_name": "STUART",
"name_prefix": "Mr.",
"credential": "PA-C, MCHS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-01",
"last_updated": "2017-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA.60331790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.