Basic Information
Provider Information
NPI: 1003294190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAPORTE
FirstName: ANNE
MiddleName: GARCES
NamePrefix: MRS.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 209 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984054265
CountryCode: US
TelephoneNumber: 2535963300
FaxNumber:  
Practice Location
Address1: 209 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984054265
CountryCode: US
TelephoneNumber: 2535963300
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2015
LastUpdateDate: 04/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOP60663768WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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