Healthcare Provider Details

I. General information

NPI: 1568505121
Provider Name (Legal Business Name): WILLIAM L. SHAUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 RAINIER AVE S
SEATTLE WA
98118-2354
US

IV. Provider business mailing address

PO BOX 34581
SEATTLE WA
98124-1581
US

V. Phone/Fax

Practice location:
  • Phone: 206-721-5600
  • Fax:
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD00014371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: