1164580494 NPI number — BRIAN JASON MACLURG M.D.

Table of content: BRIAN JASON MACLURG M.D. (NPI 1164580494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164580494 NPI number — BRIAN JASON MACLURG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACLURG
Provider First Name:
BRIAN
Provider Middle Name:
JASON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACLURG
Provider Other First Name:
JASON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164580494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 CHERRY ST
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-2023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-624-0296
Provider Business Mailing Address Fax Number:
206-624-0296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 CHERRY ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-624-0296
Provider Business Practice Location Address Fax Number:
206-624-0296
Provider Enumeration Date:
12/06/2006

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: 2084P0800X , with the licence number:  MD00024469 , 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: 1026178 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1813 . This is a "LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MD00024469 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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