Healthcare Provider Details

I. General information

NPI: 1891959862
Provider Name (Legal Business Name): AMY DAWN BROCKMEYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE MS X8-GYN
SEATTLE WA
98108-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6191
  • Fax: 206-625-7274
Mailing address:
  • Phone: 206-223-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA95508
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD60087847
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: