Healthcare Provider Details

I. General information

NPI: 1700042371
Provider Name (Legal Business Name): JUDSON RYAN HEUGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16233 SYLVESTER RD SW STE 230 SUITE 230
BURIEN WA
98166-3044
US

IV. Provider business mailing address

16233 SYLVESTER RD SW STE 230 SUITE 230
BURIEN WA
98166-3044
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-7822
  • Fax:
Mailing address:
  • Phone: 206-242-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0071995
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60511475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: