Healthcare Provider Details

I. General information

NPI: 1588730287
Provider Name (Legal Business Name): SAMIR AZIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

904 7TH AVE
SEATTLE WA
98104-1132
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-4614
  • Fax: 206-720-7414
Mailing address:
  • Phone: 206-860-4614
  • Fax: 206-720-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00044366
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: