Healthcare Provider Details

I. General information

NPI: 1720076367
Provider Name (Legal Business Name): KIRK G. ALEXANDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 301
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

1101 MADISON ST SUITE 301
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-505-1101
  • Fax:
Mailing address:
  • Phone: 206-505-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO0000779
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: