Healthcare Provider Details

I. General information

NPI: 1871773226
Provider Name (Legal Business Name): GYNECOLOGY CANCER CLINIC TR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N 115TH ST SUITE 101
SEATTLE WA
98133-8414
US

IV. Provider business mailing address

1560 N 115TH ST SUITE 101
SEATTLE WA
98133-8414
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-6806
  • Fax:
Mailing address:
  • Phone: 206-368-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRI ADAMS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 206-368-6806