Healthcare Provider Details

I. General information

NPI: 1356347579
Provider Name (Legal Business Name): JACOB R FLEET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

1560 N 115TH ST SUITE 106
SEATTLE WA
98133-8414
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1558
  • Fax: 206-368-5751
Mailing address:
  • Phone: 206-368-1558
  • Fax: 206-368-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00042503
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: