Healthcare Provider Details

I. General information

NPI: 1639179559
Provider Name (Legal Business Name): JULIE A COLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 NE BOTHELL WAY STE G
KENMORE WA
98028-9403
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-0658
  • Fax: 425-487-6761
Mailing address:
  • Phone: 425-277-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00043526
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: