Individual
ANTHONY LEE BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
AMBULATORY CLINIC, 825 EASTLAKE AVENUE EAST, SEATTLE, WA 98109
(206) 288-1000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00022980
WA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
MD00022980
WA
207RX0202X
Medical Oncology Physician
Primary
MD00022980
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0230777
L&I
WA
05
—
1932285731
—
WA
01
—
6409
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/27/2006
Last updated
10/24/2011
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