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General NPI Number Information
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NPI Number | 1447678206
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Entity Type | Individual
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Provider Name | MARIANNE EMMANUELLE DUBARD-GAULT M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2014
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Last Update Date | 11/02/2024
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Provider Practice Location Address
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Address Line | 1221 MADISON ST STE 500
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City | SEATTLE
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State | WA
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Zip | 98104-1388
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Country | US
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Telephone | 206-386-2552
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Fax | 206-215-3959
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Provider Business Mailing Address
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Address Line | PO BOX 25608
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0608
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Country | US
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Telephone | 206-320-4476
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Fax | 206-568-7043
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD60974578
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | MD60974578
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License Number State | WA
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