MEDICARE: HEAD & NECK SURGERY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558420091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAD & NECK SURGERY ASSOCIATES

Provider Business Mailing Address
First Line	:	1221 MADISON ST,
Second Line	:	SUITE#1523
City	:	SEATTLE
State	:	WA
Zip	:	98104
Country	:	US
Telephone Number	:	206-292-6464
Fax Number	:	206-292-3498

Provider Business Practice Location Address
First Line	:	1221 MADISON ST,
Second Line	:	SUITE#1523
City	:	SEATTLE
State	:	WA
Zip	:	98104
Country	:	US
Telephone Number	:	206-292-6464
Fax Number	:	206-292-3498

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID W MOORE
Credential	:	MD
Telephone Number	:	206-292-6464

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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