Healthcare Provider Details

I. General information

NPI: 1811332539
Provider Name (Legal Business Name): ASSOCIATION OF UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST UWMC PAIN CLINIC
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-6420
  • Fax: 206-520-5620
Mailing address:
  • Phone: 206-543-6420
  • Fax: 206-520-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: ANTHONY DORSCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-520-5716