Healthcare Provider Details

I. General information

NPI: 1366408858
Provider Name (Legal Business Name): ERIC D. MAILMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

2424 9TH AVE W
SEATTLE WA
98119-2521
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00035466
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00035466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: