Healthcare Provider Details

I. General information

NPI: 1992898282
Provider Name (Legal Business Name): BILL RAY EKEMO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 130TH AVE NE SUITE 211
BELLEVUE WA
98005-1755
US

IV. Provider business mailing address

2300 130TH AVE NE SUITE 211
BELLEVUE WA
98005-1755
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-1110
  • Fax: 425-869-9578
Mailing address:
  • Phone: 425-869-1110
  • Fax: 425-869-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY2206
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: