Healthcare Provider Details

I. General information

NPI: 1891889564
Provider Name (Legal Business Name): STEVEN G SUTLIEF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY VA PUGET SOUND HEALTH CARE SYSTEM
SEATTLE WA
98108
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY VA PUGET SOUND HEALTH CARE SYSTEM
SEATTLE WA
98108
US

V. Phone/Fax

Practice location:
  • Phone: 206-277-6597
  • Fax:
Mailing address:
  • Phone: 206-277-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License NumberN/A
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: