Basic Information
| Provider Information | |||||||||
| NPI: | 1285694711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMMLER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 S. MERIDIAN AVE. STE B | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537655050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 W BAY AREA BLVD | ||||||||
| Address2: | 500 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815542200 | ||||||||
| FaxNumber: | 2815544340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60914768 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | E8431 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1293193 | 05 | TX | MEDICAID |