Individual
JACK S MO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
314 NE THORNTON PL, SEATTLE, WA 98125-9000
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61312934
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205397270
—
WA
Enumeration date
03/30/2019
Last updated
07/11/2022
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