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General NPI Number Information
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NPI Number | 1073677431
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Entity Type | Organization
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Legal Business Name | VASECTOMY CENTER EASTSIDE
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2005 NW SAMMAMISH RD
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City | ISSAQUAH
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State | WA
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Zip | 98027-5364
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Country | US
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Telephone | 425-394-0773
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Fax | 425-394-0757
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Provider Business Mailing Address
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Address Line | PO BOX 94588
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City | SEATTLE
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State | WA
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Zip | 98124-6888
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Country | US
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Telephone | 206-394-0773
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JAMES E GOTTESMAN
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Credential | MD
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Telephone | 425-394-0773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | WA
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