Healthcare Provider Details

I. General information

NPI: 1609835214
Provider Name (Legal Business Name): FREDERIC B JOSEPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH NORTHWEST HOSPITAL
SEATTLE WA
98133
US

IV. Provider business mailing address

10700 MERIDIAN AVE N STE 505
SEATTLE WA
98133-9008
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1744
  • Fax: 206-368-1398
Mailing address:
  • Phone: 206-365-4100
  • Fax: 206-368-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00040376
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD00040376
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: