Healthcare Provider Details

I. General information

NPI: 1740822139
Provider Name (Legal Business Name): BELLEVUE PAIN AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 NE 29TH PL STE 230
BELLEVUE WA
98007-3630
US

IV. Provider business mailing address

14450 NE 29TH PL STE 230
BELLEVUE WA
98007-8616
US

V. Phone/Fax

Practice location:
  • Phone: 425-998-7884
  • Fax:
Mailing address:
  • Phone: 425-998-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BOWERS
Title or Position: OWNER
Credential: M.D.
Phone: 425-998-7884