Provider Demographics
NPI:1215968805
Name:CAMMARANO, WILLIAM B III
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:CAMMARANO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N D ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1718 SOUTH J STREET
Practice Address - Street 2:
Practice Address - City:TACOMAS
Practice Address - State:WA
Practice Address - Zip Code:98401
Practice Address - Country:US
Practice Address - Phone:253-627-4930
Practice Address - Fax:253-627-4649
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036295207L00000X
WI3153207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3733CAOtherB/S REGENCE 90
WA8227852Medicaid
0170292OtherL&I
WA8227852Medicaid
AB37087Medicare ID - Type Unspecified
P00011828Medicare ID - Type UnspecifiedRR