1710152327 NPI number — DR. MICHAEL JAY BADGER PH.D.

Table of content: DR. MICHAEL JAY BADGER PH.D. (NPI 1710152327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710152327 NPI number — DR. MICHAEL JAY BADGER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADGER
Provider First Name:
MICHAEL
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1710152327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46723 SE 129TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BEND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98045-8759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-619-9900
Provider Business Mailing Address Fax Number:
425-888-2959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 6TH AVE STE 2001
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-619-9900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2008

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: 103TC1900X , with the licence number:  777 , 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)