1891784468 NPI number — DR. GARRETT D ALCORN MD

Table of content: DR. GARRETT D ALCORN MD (NPI 1891784468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891784468 NPI number — DR. GARRETT D ALCORN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALCORN
Provider First Name:
GARRETT
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1891784468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16251 SYLVESTER RD SW
Provider Second Line Business Mailing Address:
HIGHLINE PATHOLOGY ASSOCIATES PC GARRETT ALCORN MD
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-431-5221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16251 SYLVESTER RD SW
Provider Second Line Business Practice Location Address:
HIGHLINE PATHOLOGY ASSOCIATES PC GARRETT ALCORN MD
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-431-5221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2005

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: 207ZP0105X , with the licence number:  MD00021159 , 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: 1034982 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220004104 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".