Healthcare Provider Details

I. General information

NPI: 1750335956
Provider Name (Legal Business Name): DAVID L. ISLAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 SYLVESTER RD SW
BURIEN WA
98166-3017
US

IV. Provider business mailing address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-9970
  • Fax:
Mailing address:
  • Phone: 425-640-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004903
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: