=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487345757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUFFIN PEDIATRICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2023
-----------------------------------------------------
Last Update Date | 12/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1631 15TH AVE W STE 103
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-2792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-752-5634
-----------------------------------------------------
Fax | 206-339-1815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1631 15TH AVE W STE 103
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98119-2792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 67-525-6342
-----------------------------------------------------
Fax | 206-339-1815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW JARED FRADKIN
-----------------------------------------------------
Credential | MD, MS
-----------------------------------------------------
Telephone | 206-752-5634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------