Healthcare Provider Details

I. General information

NPI: 1083913875
Provider Name (Legal Business Name): JULIE M RIVERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE CENTER FOR BLOOD AND CANCER DISORDERS
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE CENTER FOR BLOOD AND CANCER DISORDERS
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 60464668
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD60464668
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: