Healthcare Provider Details

I. General information

NPI: 1548226285
Provider Name (Legal Business Name): KEVIN T DOOMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 112TH AVE NE SUITE C210
BELLEVUE WA
98004-3732
US

IV. Provider business mailing address

1200 112TH AVE NE SUITE C210
BELLEVUE WA
98004-3732
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-2191
  • Fax: 425-453-1270
Mailing address:
  • Phone: 425-454-2191
  • Fax: 425-453-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD60080408
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1336-TEP
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD60080408
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: