Healthcare Provider Details

I. General information

NPI: 1386905917
Provider Name (Legal Business Name): KELLY ANNE GRIFFITH-BAUER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 200&900
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

509 OLIVE WAY STE 200&900
SEATTLE WA
98101-1720
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-5571
  • Fax: 206-860-2219
Mailing address:
  • Phone: 206-860-5571
  • Fax: 206-860-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD60847731
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPG158620
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: