1689712929 NPI number — DOUGLAS H MAR OD

Table of content: DOUGLAS H MAR OD (NPI 1689712929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689712929 NPI number — DOUGLAS H MAR OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAR
Provider First Name:
DOUGLAS
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1689712929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 9TH AVE
Provider Second Line Business Mailing Address:
MS:M4-PA
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-2756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-515-5811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13014 120TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-821-8004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007

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: 152W00000X , with the licence number:  OD00001558 , 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: US0861769 . This is a "AETNA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2101103 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA8570 . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0039597 . This is a "LABOR AND INDUSTRIES#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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