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General NPI Number Information
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NPI Number | 1679663967
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Entity Type | Organization
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Legal Business Name | QUEEN ANNE FAMILY MEDICINE INC PS
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1915 QUEEN ANNE AVE N
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City | SEATTLE
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State | WA
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Zip | 98109-2549
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Country | US
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Telephone | 206-284-6132
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Fax | 206-284-2566
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Provider Business Mailing Address
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Address Line | 1915 QUEEN ANNE AVE N
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City | SEATTLE
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State | WA
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Zip | 98109-2549
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Country | US
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Telephone | 206-284-6132
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Fax | 206-284-2566
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE GARDNER
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Credential | MD
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Telephone | 206-284-6132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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