1316914716 NPI number — MR. WALTER B HOLLOW MD

Table of content: MR. WALTER B HOLLOW MD (NPI 1316914716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316914716 NPI number — MR. WALTER B HOLLOW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOW
Provider First Name:
WALTER
Provider Middle Name:
B
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:
HOLLOW
Provider Other First Name:
WALT
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316914716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9800 4TH AVENUE NE
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:
98115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-302-1248
Provider Business Mailing Address Fax Number:
206-302-1263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 4TH AVENUE NE
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:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-1248
Provider Business Practice Location Address Fax Number:
206-302-1263
Provider Enumeration Date:
03/03/2006

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: 103T00000X , with the licence number:  MD00015655 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD00015655 , 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: 8446809 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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