Basic Information
| Provider Information | |||||||||
| NPI: | 1487650883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIGUEROA | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1529 | ||||||||
| Address2: | 905 EAST D STREET | ||||||||
| City: | DEER PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990061529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092765005 | ||||||||
| FaxNumber: | 5092767785 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 E D STREET | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092765005 | ||||||||
| FaxNumber: | 5092767785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 08/05/2011 | ||||||||
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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 | 207Q00000X | MD00018431 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 124535 | 01 | WA | L&I | OTHER | 8309569 | 05 | WA | MEDICAID |