Healthcare Provider Details

I. General information

NPI: 1831264043
Provider Name (Legal Business Name): TIFFANY SPANIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 136TH AVE SE SUITE #110
BELLEVUE WA
98006
US

IV. Provider business mailing address

3633 136TH AVE SE SUITE #110
BELLEVUE WA
98006
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-7202
  • Fax: 425-643-0635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00041495
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: