Provider Demographics
NPI:1205951076
Name:DAHL, CHRISTIAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:WILLIAM
Last Name:DAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9314 227TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-7433
Mailing Address - Country:US
Mailing Address - Phone:253-260-2056
Mailing Address - Fax:360-407-0955
Practice Address - Street 1:1009 COLLEGE ST.
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5310
Practice Address - Country:US
Practice Address - Phone:360-407-1508
Practice Address - Fax:360-407-0955
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8103384Medicaid
WAA06022Medicare UPIN