Healthcare Provider Details

I. General information

NPI: 1235206558
Provider Name (Legal Business Name): BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 112TH AVE NE SUITE A101 & A102
BELLEVUE WA
98004-3782
US

IV. Provider business mailing address

PO BOX 31001-1839 BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
PASADENA CA
91110-1839
US

V. Phone/Fax

Practice location:
  • Phone: 425-637-1022
  • Fax: 425-637-2011
Mailing address:
  • Phone: 425-637-1022
  • Fax: 425-637-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number601913899
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD00024795
License Number StateWA

VIII. Authorized Official

Name: HENRY JOSEPH WILLIAMS
Title or Position: MEMBER
Credential: M.D.
Phone: 425-637-1022