Healthcare Provider Details

I. General information

NPI: 1982752069
Provider Name (Legal Business Name): STEVEN JOHN ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PLACE SUITE 304
SEATTLE WA
98105-4093
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-1422
  • Fax: 206-523-3101
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD00021245
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: