Basic Information
| Provider Information | |||||||||
| NPI: | 1285814129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMING | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 732 SUMMITVIEW AVE | ||||||||
| Address2: | #621 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095733448 | ||||||||
| FaxNumber: | 5095744481 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 11TH AVE | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092483954 | ||||||||
| FaxNumber: | 5092493955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 01/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10005313 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 8498313 | 05 | WA | MEDICAID |