| Edson Gerry Ponraj, MD | |
|
11315 Bridgeport Way Sw, Lakewood, WA 98499-3004 | |
| (253) 589-8700 | |
| (253) 581-6588 |
| Full Name | Edson Gerry Ponraj |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 11315 Bridgeport Way Sw, Lakewood, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396783940 | NPI | - | NPPES |
| 1186PO | Other | WA | BSWA |
| 8400749 | Medicaid | WA | |
| 0186779 | Other | WA | LIWA |
| 0186778 | Other | WA | LIWA |
| 2165PO | Other | WA | BSWA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | MD00043988 (Washington) | Primary |
| Entity Name | Northwest Emergency Physicians Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1235172370 PECOS PAC ID: 3476462334 Enrollment ID: O20041214000892 |
| Mailing Address | Practice Location Address |
|---|---|
| Edson Gerry Ponraj, MD 505 S 336th St, Suite 600, Federal Way, WA 98003-6328 Ph: (253) 838-6180 | Edson Gerry Ponraj, MD 11315 Bridgeport Way Sw, Lakewood, WA 98499-3004 Ph: (253) 589-8700 |
Kelly A Phillips, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 11315 Bridgeport Way Sw, Emergency Dept, Lakewood, WA 98499 Phone: 253-985-8700 | |
Matthew M Rice, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 11315 Bridgeport Way Sw, Lakewood, WA 98499 Phone: 253-588-1711 Fax: 253-581-6588 | |
James Bae Lee, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 11315 Bridgeport Way Sw, Lakewood, WA 98499 Phone: 253-588-1711 Fax: 253-944-7922 | |
Sean Thomas Baxter, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 11315 Bridgeport Way Sw, Lakewood, WA 98499 Phone: 253-589-8700 Fax: 253-581-6588 | |
Michael J Larson, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 11315 Bridgeport Way Sw, Lakewood, WA 98499 Phone: 253-588-1711 Fax: 253-838-6418 | |
Ian David Cowan, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 11315 Bridgeport Way Sw, Lakewood, WA 98499 Phone: 253-588-1711 Fax: 253-838-6418 |