Healthcare Provider Details

I. General information

NPI: 1568408912
Provider Name (Legal Business Name): DAVID ALFRED HANSCOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 17TH AVE #500
SEATTLE WA
98122-5788
US

IV. Provider business mailing address

3130 E MADISON ST #205
SEATTLE WA
98112-4264
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2800
  • Fax: 206-320-2887
Mailing address:
  • Phone: 206-329-2393
  • Fax: 206-329-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD00018423
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: