=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235359688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEDERAL WAY FAMILY PHYSICIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34616 11TH PLACE SOUTH SUITE #4
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-927-9460
-----------------------------------------------------
Fax | 253-927-2168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34616 11TH PLACE SOUTH SUITE #4
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-927-9460
-----------------------------------------------------
Fax | 253-927-2168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALLEN C ALLEMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 253-927-9460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD00015576
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------