Healthcare Provider Details

I. General information

NPI: 1275583833
Provider Name (Legal Business Name): DOUGLAS J. BIRKEBAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/08/2020
Certification Date: 02/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 SYLVESTER RD SW
BURIEN WA
98166-3017
US

IV. Provider business mailing address

PO BOX 94391 MS/LB 310054
SEATTLE WA
98124-6691
US

V. Phone/Fax

Practice location:
  • Phone: 206-431-5314
  • Fax:
Mailing address:
  • Phone: 888-579-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10002010
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10002010
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: