Healthcare Provider Details

I. General information

NPI: 1649312695
Provider Name (Legal Business Name): NORTHWEST PAIN CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 116TH AVE NE SUITE 102
BELLEVUE WA
98004-3049
US

IV. Provider business mailing address

1607 116TH AVE NE SUITE 102
BELLEVUE WA
98004-3049
US

V. Phone/Fax

Practice location:
  • Phone: 425-450-1015
  • Fax:
Mailing address:
  • Phone: 425-450-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD00026655
License Number StateWA

VIII. Authorized Official

Name: DAVID S GOODMAN
Title or Position: OWNER
Credential: MD
Phone: 425-450-1015