Healthcare Provider Details

I. General information

NPI: 1831341569
Provider Name (Legal Business Name): BALLARD WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 BARNES AVE NW
SEATTLE WA
98107-3839
US

IV. Provider business mailing address

5410 BARNES AVE NW
SEATTLE WA
98107-3839
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-0810
  • Fax: 206-784-2250
Mailing address:
  • Phone: 206-784-0810
  • Fax: 206-784-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD00029025
License Number StateWA

VIII. Authorized Official

Name: DR. PETER BRANDON
Title or Position: PARTNER
Credential: M.D.
Phone: 206-784-0810