1427073717 NPI number — DANIEL PERRY FOSMIRE M.D.

Table of content: DANIEL PERRY FOSMIRE M.D. (NPI 1427073717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427073717 NPI number — DANIEL PERRY FOSMIRE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSMIRE
Provider First Name:
DANIEL
Provider Middle Name:
PERRY
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:
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:
1427073717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-6868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-846-5527
Provider Business Mailing Address Fax Number:
607-324-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 116TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-709-7055
Provider Business Practice Location Address Fax Number:
425-709-7066
Provider Enumeration Date:
07/13/2006

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: 207T00000X , with the licence number:  MD00037143 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD0037143 , 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: 8238685 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4491936 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0182685 . This is a "L & I WORKERS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5368FO . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8930609 . This is a "L & I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 21171261225 . This is a "UNIFORM MEDICAL PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1223348 08 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 770614555 . This is a "TRIWEST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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