Healthcare Provider Details

I. General information

NPI: 1154453389
Provider Name (Legal Business Name): WAYNE FOX LARRABEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY SUITE 280
SEATTLE WA
98122-5395
US

IV. Provider business mailing address

600 BROADWAY SUITE 280
SEATTLE WA
98122-5395
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-3550
  • Fax: 206-386-3553
Mailing address:
  • Phone: 206-386-3550
  • Fax: 206-386-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD00017636
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: