Healthcare Provider Details

I. General information

NPI: 1972770352
Provider Name (Legal Business Name): MONROE ANESTHESIA PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
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 94570
SEATTLE WA
98124-6870
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUZANNE ISOM
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-407-1000