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General NPI Number Information
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NPI Number | 1972872885
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Entity Type | Individual
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Provider Name | LON S ANNEST MD, MBA
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Gender | Male
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 2101 FREDERICK DOUGLASS BLVD 10B
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City | NEW YORK
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State | NY
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Zip | 10026-3469
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Country | US
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Telephone | 253-279-0281
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Fax | 646-649-4010
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Provider Business Mailing Address
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Address Line | 2423 NO. 31ST STREET
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City | TACOMA
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State | WA
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Zip | 98407-6401
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Country | US
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Telephone | 253-279-0281
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Fax | 646-641-4010
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 14851
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License Number State | WA
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