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General NPI Number Information
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NPI Number | 1508976531
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Entity Type | Individual
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Provider Name | BRUCE LAWRENCE WILLIAMS-BURDEN PA
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-764-2245
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Fax | 206-764-2753
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Provider Business Mailing Address
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Address Line | 16229 SE 31ST ST
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City | BELLEVUE
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State | WA
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Zip | 98008-5704
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Country | US
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Telephone | 425-644-2215
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Fax | 206-764-2753
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA10000375
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License Number State | WA
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