Healthcare Provider Details

I. General information

NPI: 1043583586
Provider Name (Legal Business Name): STEVEN J ANDERSON MD INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PL SUITE 304
SEATTLE WA
98105-4093
US

IV. Provider business mailing address

3216 NE 45TH PL SUITE 304
SEATTLE WA
98105-4093
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-1422
  • Fax: 206-523-3101
Mailing address:
  • Phone: 206-523-1422
  • Fax: 206-523-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number00021245
License Number StateWA

VIII. Authorized Official

Name: DR. STEVEN J ANDERSON
Title or Position: OWNER
Credential: MD
Phone: 206-523-1422