Healthcare Provider Details

I. General information

NPI: 1437335296
Provider Name (Legal Business Name): GERALD T NEPOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 9TH AVE
SEATTLE WA
98101-2795
US

IV. Provider business mailing address

1100 9TH AVE MS M4-PA
SEATTLE WA
98102-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-8812
  • Fax:
Mailing address:
  • Phone: 206-583-6025
  • Fax: 206-515-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License NumberMD00019886
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: