Healthcare Provider Details

I. General information

NPI: 1912422049
Provider Name (Legal Business Name): ALEXANDER SPENCER LIMOGES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 04/12/2020
Certification Date: 04/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-3076
US

IV. Provider business mailing address

111 TERRY AVE N APT 2107
SEATTLE WA
98109-5980
US

V. Phone/Fax

Practice location:
  • Phone: 360-624-3615
  • Fax:
Mailing address:
  • Phone: 360-624-3615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN60286257
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP61037393
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: