Healthcare Provider Details

I. General information

NPI: 1306817481
Provider Name (Legal Business Name): PAUL H DREYFUSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 NE 128TH ST SUITE 530
KIRKLAND WA
98034-7208
US

IV. Provider business mailing address

PO BOX 34036
SEATTLE WA
98124-1036
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-1111
  • Fax: 425-454-7653
Mailing address:
  • Phone: 425-899-3292
  • Fax: 425-899-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00040561
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD00040561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: