Basic Information
Provider Information | |||||||||
NPI: | 1326438052 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YAGER | ||||||||
FirstName: | ALEXA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DIX | ||||||||
OtherFirstName: | ALEXA | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 850 | ||||||||
Address2: |   | ||||||||
City: | PORT ANGELES | ||||||||
State: | WA | ||||||||
PostalCode: | 983620146 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073142189 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 939 CAROLINE ST | ||||||||
Address2: |   | ||||||||
City: | PORT ANGELES | ||||||||
State: | WA | ||||||||
PostalCode: | 98362 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3604177000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2015 | ||||||||
LastUpdateDate: | 06/21/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | UO 4288 | FL | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 60846428 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.