Healthcare Provider Details

I. General information

NPI: 1467920884
Provider Name (Legal Business Name): JOSHUA JAMES MCLEOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2018
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date: 08/17/2020
Reactivation Date: 08/28/2020

III. Provider practice location address

999 164TH AVE NE
BELLEVUE WA
98008-3518
US

IV. Provider business mailing address

999 164TH AVE NE
BELLEVUE WA
98008-3518
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-4937
  • Fax:
Mailing address:
  • Phone: 425-747-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: