1225278955 NPI number — MARY-ELIZABETH MUCHMORE PERCIVAL M.D.

Table of content: MARY-ELIZABETH MUCHMORE PERCIVAL M.D. (NPI 1225278955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225278955 NPI number — MARY-ELIZABETH MUCHMORE PERCIVAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERCIVAL
Provider First Name:
MARY-ELIZABETH
Provider Middle Name:
MUCHMORE
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:
MUCHMORE
Provider Other First Name:
MARY-ELIZABETH
Provider Other Middle Name:
ANSELMO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225278955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 358081 / MS G6-075
Provider Second Line Business Mailing Address:
UNIVERSITY OF WASHINGTON
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 EASTLAKE AVE E
Provider Second Line Business Practice Location Address:
SEATTLE CANCER CARE ALLIANCE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-6190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2009

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: 207R00000X , with the licence number:  A106581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0000X , with the licence number: MD.MD.60591746 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: A106581 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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