Organization
LONGEVITY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY N MIXON M.D. (MEDICAL DIRECTOR)
(425) 576-9272
Entity
Organization
Contact information
Practice address
9757 NE JUANITA DR, SUITE 200, KIRKLAND, WA 98034-4299
(425) 576-9272
(425) 576-0894
Mailing address
9757 NE JUANITA DR, SUITE 200, KIRKLAND, WA 98034-4299
(425) 576-9272
(425) 576-0894
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD23643
WA
Other
Enumeration date
04/10/2007
Last updated
06/21/2011
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