Healthcare Provider Details

I. General information

NPI: 1013932680
Provider Name (Legal Business Name): DENNIS MAYOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDIATRICS, BOX 356320 UNIVERSITY OF WASHINGTON
SEATTLE WA
98195-6320
US

IV. Provider business mailing address

PEDIATRICS, BOX 356320 UNIVERSITY OF WASHINGTON
SEATTLE WA
98195-6320
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD00016391
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: