Healthcare Provider Details

I. General information

NPI: 1093973307
Provider Name (Legal Business Name): G BRIAN DOUAY BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4616 25TH AVE NE # 292
SEATTLE WA
98105-4183
US

IV. Provider business mailing address

4616 25TH AVE NE # 292
SEATTLE WA
98105-4183
US

V. Phone/Fax

Practice location:
  • Phone: 206-280-6533
  • Fax:
Mailing address:
  • Phone: 206-280-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: