=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972527141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEOFFREY MACPHERSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6920 COAL CREEK PKWY SE STE 12
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98059-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-656-4095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 LIND AVE SW STE 100
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-4934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-656-5412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | MD00011292
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------