Provider Demographics
NPI:1871586776
Name:LEDOUX, EDWARD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:LEDOUX
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 1:316 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:STE 401
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4252
Mailing Address - Country:US
Mailing Address - Phone:253-572-5140
Mailing Address - Fax:
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:STE 401
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4252
Practice Address - Country:US
Practice Address - Phone:253-572-5140
Practice Address - Fax:253-272-0419
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25328207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8109241Medicaid
WA290011532OtherRR MEDICARE
WA8109241Medicaid
GAB07230-PIERCE COMedicare PIN
WAA06436Medicare UPIN