1720009947 NPI number — DANIEL W. GOTTLIEB, M.D., P.S.

Table of content: (NPI 1720009947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720009947 NPI number — DANIEL W. GOTTLIEB, M.D., P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL W. GOTTLIEB, M.D., P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DANIEL W. GOTTLIEB, MD
Provider Other Organization Name Type Code:
3
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:
1720009947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16259 SYLVESTER RD SW
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-3049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-592-5000
Provider Business Mailing Address Fax Number:
206-824-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16259 SYLVESTER RD SW
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-241-7146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOTTLIEB
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-241-7146

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060009854 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1001585 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".