Healthcare Provider Details

I. General information

NPI: 1619068970
Provider Name (Legal Business Name): JEFFREY W. DASSEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 2ND ST
RENTON WA
98057-2007
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-424-6310
  • Fax:
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD60319925
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60319925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: