1225227150 NPI number — RUSSELL TROUTMAN MD PA

Table of content: MRS. STACIA MARIE DUNSON NP (NPI 1689929366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225227150 NPI number — RUSSELL TROUTMAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL TROUTMAN MD PA
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:
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:
1225227150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 MADISON ST
Provider Second Line Business Mailing Address:
SUITE 901
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-1172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-264-8100
Provider Business Mailing Address Fax Number:
206-264-8689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16122 8TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE D-1
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-1680
Provider Business Practice Location Address Fax Number:
206-243-8845
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TROUTMAN
Authorized Official First Name:
HOLMES
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
206-244-1680

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME77559 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 256213800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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