Healthcare Provider Details

I. General information

NPI: 1023062205
Provider Name (Legal Business Name): PHYSICIANS ANESTHESIA OF MONROE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 179TH AVE SE
MONROE WA
98272-1108
US

IV. Provider business mailing address

PO BOX 94061
SEATTLE WA
98124-9461
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7497
  • Fax:
Mailing address:
  • Phone: 425-353-3788
  • Fax: 425-353-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: DERMOT CHAMBERLAIN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 425-353-2840