Healthcare Provider Details

I. General information

NPI: 1528158698
Provider Name (Legal Business Name): JEFFREY T SCHOUTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE BOX 359930
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE BOX 359930
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-760-0093
  • Fax: 206-760-0093
Mailing address:
  • Phone: 206-760-0093
  • Fax: 206-760-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD00028290
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00028290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: