Bruce Dykeman, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00002833 Issued in WA

Practice address

4423 Point Fosdick Dr NW
Suite 200
Gig Harbor, WA 98335-1797

Phone

(262) 909-0105

NPI assigned

Jul 19, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gig Harbor Primary Care LLC

  • Primary Care Clinic/Center
  • Gig Harbor, WA
  • NPI 1447607478
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1265632244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1487",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983353487",
            "telephone_number": "262-909-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4423 POINT FOSDICK DR NW",
            "address_2": "SUITE 200",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351797",
            "telephone_number": "262-909-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKEMAN",
        "first_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00002833",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1485",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71-002164",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN PSYCHOLOGIST",
            "identifier": "1485",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS PSYCHOLOGIST",
            "identifier": "71-002164",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON PSYCHOLOGIST",
            "identifier": "PY00002833",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Austin Duclos, PHARMD
• Michael Schaefer Dunbry, MA
• Diana Duncan, ND
• John E. Duppenthaler, D.C.
• Chinyelu Ada Duxbury, D.O.
• Kimberly A Ebert
• Breanna Rose Eden, LMP
• Michelle Suzanne Edstrom, MD
• Joshua Edwards
• Lawrence Alfred Edwards, PH.D.

• Clinical Psychologist in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.