Provider Demographics
NPI:1548226285
Name:DOOMS, KEVIN T (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:DOOMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 112TH AVE NE
Mailing Address - Street 2:SUITE C210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3732
Mailing Address - Country:US
Mailing Address - Phone:425-454-2191
Mailing Address - Fax:425-453-1270
Practice Address - Street 1:1200 112TH AVE NE
Practice Address - Street 2:SUITE C210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3732
Practice Address - Country:US
Practice Address - Phone:425-454-2191
Practice Address - Fax:425-453-1270
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60080408207K00000X, 2080P0201X
WI1336-TEP208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8547648Medicaid
WA0067890OtherL&I
WA0067890OtherL&I