Provider Demographics
NPI:1043392046
Name:TOULOUSE, DOMINICK R (MD)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:R
Last Name:TOULOUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S
Mailing Address - Street 2:STE 440
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-793-4702
Mailing Address - Fax:425-271-5382
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:SUITE 440
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-793-4702
Practice Address - Fax:425-271-5382
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAM000020685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1289305Medicaid
WA110131431OtherRR MEDICARE
A05805Medicare UPIN
WA110131431OtherRR MEDICARE