Healthcare Provider Details

I. General information

NPI: 1790778793
Provider Name (Legal Business Name): DANIEL W GOTTLIEB MD PS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16122 8TH AVE SW STE D1
BURIEN WA
98166-2967
US

IV. Provider business mailing address

PO BOX 66596
SEATTLE WA
98166-0596
US

V. Phone/Fax

Practice location:
  • Phone: 206-241-7146
  • Fax:
Mailing address:
  • Phone: 206-241-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00021018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: