Healthcare Provider Details

I. General information

NPI: 1487885133
Provider Name (Legal Business Name): PATRICK G ALONSO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 11TH AVENUE NE, SUITE 200 MEDEX NORTHWEST
SEATTLE WA
98105
US

IV. Provider business mailing address

4311 11TH AVENUE NE, SUITE 200 MEDEX NORTHWEST
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-4001
  • Fax:
Mailing address:
  • Phone: 206-616-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number105297
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: