Healthcare Provider Details

I. General information

NPI: 1659640191
Provider Name (Legal Business Name): DAVID ALAN SIMONOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22621 NE 114TH ST
REDMOND WA
98053-5603
US

IV. Provider business mailing address

22621 NE 114TH ST
REDMOND WA
98053-5603
US

V. Phone/Fax

Practice location:
  • Phone: 425-890-4653
  • Fax:
Mailing address:
  • Phone: 425-890-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD 00013447
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: