Individual
NASSR NAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(206) 987-2000
Mailing address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(206) 660-3561
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD61324202
WA
Other
Enumeration date
04/06/2023
Last updated
04/14/2023
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