Healthcare Provider Details

I. General information

NPI: 1982722534
Provider Name (Legal Business Name): RALPH D HAVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 150TH AVE SE
BELLEVUE WA
98006-1668
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 425-460-7140
  • Fax: 425-460-7129
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60072857
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: