Healthcare Provider Details

I. General information

NPI: 1427294677
Provider Name (Legal Business Name): TREEHOUSE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MADRONA ST
EASTSOUND WA
98245-8573
US

IV. Provider business mailing address

429 MADRONA ST
EASTSOUND WA
98245-8573
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-7337
  • Fax: 888-543-7977
Mailing address:
  • Phone: 360-376-7337
  • Fax: 888-543-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60027949
License Number StateWA

VIII. Authorized Official

Name: EVAN R BUXBAUM
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 360-376-7337