Healthcare Provider Details

I. General information

NPI: 1700053790
Provider Name (Legal Business Name): THOMAS J DEAL MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5343 TALLMAN AVE NW 203
SEATTLE WA
98107-3931
US

IV. Provider business mailing address

5343 TALLMAN AVE NW 203
SEATTLE WA
98107-3931
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-5555
  • Fax: 206-789-5699
Mailing address:
  • Phone: 206-789-5555
  • Fax: 206-789-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD00016837
License Number StateWA

VIII. Authorized Official

Name: DR. THOMAS J DEAL
Title or Position: PRESIDENT
Credential: MD
Phone: 206-789-5555