Healthcare Provider Details

I. General information

NPI: 1730148867
Provider Name (Legal Business Name): STEVEN WAYNE ROSTAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4307
US

IV. Provider business mailing address

PO BOX 3941
SEATTLE WA
98124-3941
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6000
  • Fax:
Mailing address:
  • Phone: 206-386-2676
  • Fax: 206-386-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberMD00024754
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD00024754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: