Healthcare Provider Details

I. General information

NPI: 1780794743
Provider Name (Legal Business Name): JOSHUA P THALER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST C-212, BOX 356340
SEATTLE WA
98195-6340
US

IV. Provider business mailing address

1959 NE PACIFIC ST C-212, BOX 356340
SEATTLE WA
98195-6340
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-0065
  • Fax:
Mailing address:
  • Phone: 206-543-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00045606
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00045606
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: