MEDICARE: DR. ELISABETH SIMARD-TREMBLAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	ML60217156	WA

General Provider Information

NPI Number	:	1104104322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH SIMARD-TREMBLAY M.D.

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	BOX 356465
City	:	SEATTLE
State	:	WA
Zip	:	98195-6465
Country	:	US
Telephone Number	:	206-598-5068
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	BOX 356465
City	:	SEATTLE
State	:	WA
Zip	:	98195-6465
Country	:	US
Telephone Number	:	206-598-5068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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