Healthcare Provider Details

I. General information

NPI: 1902034770
Provider Name (Legal Business Name): PACIFIC NORTHWEST FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY SUITE 280
SEATTLE WA
98122-5395
US

IV. Provider business mailing address

600 BROADWAY SUITE 280
SEATTLE WA
98122-5395
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-3550
  • Fax: 206-386-3553
Mailing address:
  • Phone: 206-386-3550
  • Fax: 206-386-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYNE FOX LARRABEE
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 206-386-3550