Healthcare Provider Details

I. General information

NPI: 1700895000
Provider Name (Legal Business Name): PAUL ARTHUR MERGUERIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # MSW-7229 DIVISION OF PEDIATRIC UROLOGY
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # MSW-7229 DIVISION OF PEDIATRIC UROLOGY
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-1623
  • Fax: 206-987-3925
Mailing address:
  • Phone: 206-987-1623
  • Fax: 206-987-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD60238195
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD60238195
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: