Healthcare Provider Details

I. General information

NPI: 1699918169
Provider Name (Legal Business Name): IAN R WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135-116TH AVENUE NE SUITE 550
BELLEVUE WA
98004
US

IV. Provider business mailing address

MS 315010 PO BOX 3947
SEATTLE WA
98124-3947
US

V. Phone/Fax

Practice location:
  • Phone: 425-646-7400
  • Fax: 425-646-7449
Mailing address:
  • Phone: 425-467-3655
  • Fax: 425-635-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD179551
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD60858867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: