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General NPI Number Information
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NPI Number | 1790061158
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE OF SEATTLE, PLLC
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 1530 N 115TH ST. SUITE 104
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City | SEATTLE
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State | WA
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Zip | 98133-8417
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Country | US
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Telephone | 206-368-1311
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Fax | 206-366-0907
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Provider Business Mailing Address
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Address Line | 1530 N 115TH ST. SUITE 104
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City | SEATTLE
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State | WA
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Zip | 98133-8417
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Country | US
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Telephone | 206-368-1311
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Fax | 206-366-0907
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JERI C LEER
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Credential |
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Telephone | 206-368-1311
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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 | 60099255
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License Number State | WA
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