Healthcare Provider Details

I. General information

NPI: 1053422048
Provider Name (Legal Business Name): ERLAN SERICZHANULY TOULEGENOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST SURGICAL SERVICES MS B-250
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

1550 N 115TH ST SURGICAL SERVICES MS B-250
SEATTLE WA
98133
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1008
  • Fax:
Mailing address:
  • Phone: 206-368-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00045890
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: