1184620536 NPI number — JANET SELTZER M.D.

Table of content: JANET SELTZER M.D. (NPI 1184620536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184620536 NPI number — JANET SELTZER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELTZER
Provider First Name:
JANET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184620536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5096
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98227-5096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-738-2200
Provider Business Mailing Address Fax Number:
360-752-5687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4545 CORDATA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-7123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-738-2200
Provider Business Practice Location Address Fax Number:
360-752-5687
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  MD00026136 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8112237 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4835SE . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MD1492W , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4585733 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0229983 . This is a "L&I AND CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1184620536 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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