Healthcare Provider Details

I. General information

NPI: 1356823843
Provider Name (Legal Business Name): JEFFREY JAY HUOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY
SEATTLE WA
98104
US

IV. Provider business mailing address

325 9TH AVE # MS 359797
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9646
  • Fax: 206-744-9854
Mailing address:
  • Phone: 206-744-9646
  • Fax: 206-744-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: