1942232913 NPI number — MR. DAVID J SPINAK MD

Table of content: MR. DAVID J SPINAK MD (NPI 1942232913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942232913 NPI number — MR. DAVID J SPINAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPINAK
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
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:
1942232913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22232 17TH AVE SE STE 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-7425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-296-3837
Provider Business Mailing Address Fax Number:
206-215-3870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 LEVIN RD NW
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-7849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-307-0300
Provider Business Practice Location Address Fax Number:
360-307-0302
Provider Enumeration Date:
07/07/2006

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: 207W00000X , with the licence number:  MD00045166 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0107X , with the licence number: MD00045166 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7129216 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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