Healthcare Provider Details

I. General information

NPI: 1538146832
Provider Name (Legal Business Name): RICHARD DAVID KOVAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 19TH AVE E
SEATTLE WA
98112-4007
US

IV. Provider business mailing address

500 19TH AVE E
SEATTLE WA
98112-4007
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-1600
  • Fax: 206-299-1608
Mailing address:
  • Phone: 206-299-1600
  • Fax: 206-299-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00021679
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: