Healthcare Provider Details

I. General information

NPI: 1912324559
Provider Name (Legal Business Name): FLOYD SEKERAMAYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N FAIRVIEW DR
TACOMA WA
98406-1015
US

IV. Provider business mailing address

630 N FAIRVIEW DR
TACOMA WA
98406-1015
US

V. Phone/Fax

Practice location:
  • Phone: 253-314-6904
  • Fax: 605-274-2281
Mailing address:
  • Phone: 253-314-6904
  • Fax: 605-274-2281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60300185
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60300185
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: