Provider Demographics
NPI:1447281613
Name:ENKEMA, LOUIS CORNELIUS JR (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:CORNELIUS
Last Name:ENKEMA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7440 PACIFIC AVE
Mailing Address - Street 2:SPANAWAY GENERAL MEDICAL CLINIC
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7117
Mailing Address - Country:US
Mailing Address - Phone:253-475-0511
Mailing Address - Fax:253-475-7440
Practice Address - Street 1:7440 PACIFIC AVE
Practice Address - Street 2:SPANAWAY GENERAL MEDICAL CLINIC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7117
Practice Address - Country:US
Practice Address - Phone:253-475-0511
Practice Address - Fax:253-475-7440
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00017653208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA117028Medicaid
A06471Medicare UPIN
AB02699Medicare ID - Type Unspecified