Individual
RICHARD E SEROUSSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3213 EASTLAKE AVE E, SUITE A, SEATTLE, WA 98102-3826
(206) 861-8200
(206) 324-1178
Mailing address
3213 EASTLAKE AVE E, SUITE A, SEATTLE, WA 98102-3826
(206) 861-8200
(206) 324-1178
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD00031281
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158738
LABOR & INDUSTRIES
WA
05
—
8179723
—
WA
01
—
9006SE
REGENCE RIDER NUMBER
WA
Enumeration date
07/17/2006
Last updated
12/17/2018
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