Healthcare Provider Details

I. General information

NPI: 1649268210
Provider Name (Legal Business Name): WILLIAM A PORTUESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 1280
SEATTLE WA
98104-3510
US

IV. Provider business mailing address

1101 MADISON ST SUITE 1280
SEATTLE WA
98104-3510
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-6200
  • Fax: 206-624-0244
Mailing address:
  • Phone: 206-624-6200
  • Fax: 206-624-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00028539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: