Healthcare Provider Details

I. General information

NPI: 1063432292
Provider Name (Legal Business Name): JOSE A GUDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

747 BROADWAY
SEATTLE WA
98122-4379
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2520
  • Fax: 206-386-3180
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-13967
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00038259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: