Healthcare Provider Details

I. General information

NPI: 1982053872
Provider Name (Legal Business Name): DANNY MAMMO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 3RD ST NE STE 200
AUBURN WA
98002-4035
US

IV. Provider business mailing address

125 3RD ST NE STE 200
AUBURN WA
98002-4035
US

V. Phone/Fax

Practice location:
  • Phone: 253-275-1000
  • Fax: 253-275-9000
Mailing address:
  • Phone: 253-275-1000
  • Fax: 253-275-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.MD.70183421
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.138669
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301110304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: