Healthcare Provider Details

I. General information

NPI: 1548368731
Provider Name (Legal Business Name): TROY L. MCGUIRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE T-0111
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE T-0111
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-7096
  • Fax: 206-987-3830
Mailing address:
  • Phone: 206-987-7096
  • Fax: 206-987-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55019
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60205612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: