Individual
JESSE R FANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
UNIVERSITY OF WASHINGTON MEDICAL CTR, 1959 NE PACIFIC ST, SEATTLE, WA 98195-6560
(206) 598-6195
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00029120
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0175609
L&I
WA
05
—
1750466553
—
WA
01
—
8881
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/27/2006
Last updated
01/30/2012
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