Provider Demographics
NPI:1386083681
Name:VAN DYKE, RUFUS IV (MD)
Entity type:Individual
Prefix:
First Name:RUFUS
Middle Name:
Last Name:VAN DYKE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 N DIVISION ST STE 310
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4931
Practice Address - Country:US
Practice Address - Phone:253-792-6555
Practice Address - Fax:253-833-1071
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57 . 023541207X00000X
WAMD60944075207X00000X
OH023541207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery