Healthcare Provider Details

I. General information

NPI: 1841734035
Provider Name (Legal Business Name): RICHARD REPASS, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 78TH AVE SE STE 100
MERCER ISLAND WA
98040-2843
US

IV. Provider business mailing address

PO BOX 1775
MERCER ISLAND WA
98040-1775
US

V. Phone/Fax

Practice location:
  • Phone: 425-652-4812
  • Fax: 425-364-4966
Mailing address:
  • Phone: 425-652-4812
  • Fax: 425-818-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD EDUARDO REPASS
Title or Position: OWNER
Credential: MD
Phone: 425-652-4812