Healthcare Provider Details

I. General information

NPI: 1700814589
Provider Name (Legal Business Name): MARY E. BUTCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 DUVALL AVE NE STE 100
RENTON WA
98059-4675
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98055-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5500
  • Fax: 425-656-5542
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD00019355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: