Tyler Douma

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60660643 Issued in WA

Practice address

9019 E Mission Ave
Spokane Valley Office
Spokane, WA 99212

Phone

(855) 433-6825

NPI assigned

Feb 10, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1548628175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9019 E MISSION AVE",
            "address_2": "SPOKANE VALLEY OFFICE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99212",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUMA",
        "first_name": "TYLER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "RR 60559973",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60660643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTPIN",
            "identifier": "54456158",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kory L Douglas, PLMP
• Ronald J Douglas, D.P.M.
• Tinsley Claire Douglas, MS GENETIC COUNSELOR
• Shauna Joelle Douglass-Parkin, EAMP, L.AC.
• Avery Douglass, DMD
• Avery Clarence Doutre
• Maura Elaine Dover
• Kevin William Dow, D.P.M.
• Amy Dowell
• Shaham Dowlatshahi, PHARMD

• General Practice Dentistry in Spokane, WA
• Providers in Spokane, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.