Healthcare Provider Details

I. General information

NPI: 1063611275
Provider Name (Legal Business Name): JALAL B ANDRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET, NW011 BOX 357115
SEATTLE WA
98195-7115
US

IV. Provider business mailing address

BOX 357115 1959 NE PACIFIC STREET, NW011
SEATTLE WA
98195-7115
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-8766
  • Fax: 206-598-8475
Mailing address:
  • Phone: 206-598-8766
  • Fax: 206-598-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA107739
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60217663
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: