Healthcare Provider Details

I. General information

NPI: 1942524400
Provider Name (Legal Business Name): ERIC JON ALLENSPACH M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE MA.7.110
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE MA.7.110
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberMD 60341673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: