Individual
JORDAN M PRUTKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.H.S.
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-6340
(206) 543-0065
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD00044698
WA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD00044698
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0250653
L&I
WA
05
—
1760597488
—
WA
Enumeration date
08/21/2006
Last updated
11/21/2012
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