MEDICARE: PULMONARY RESPIRATORY EXPERT PHYSICIANS, PLLC

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD00044635	WA
2	207RP1001X	Pulmonary Disease Physician	MD00044635	WA

General Provider Information

NPI Number	:	1699007260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY RESPIRATORY EXPERT PHYSICIANS, PLLC

Provider Business Mailing Address
First Line	:	7068 WING POINT RD NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2987
Country	:	US
Telephone Number	:	206-842-2379
Fax Number	:	206-842-2379

Provider Business Practice Location Address
First Line	:	7068 WING POINT RD NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2987
Country	:	US
Telephone Number	:	206-842-2379
Fax Number	:	206-842-2379

Authorized Official
Title or Position	:	MEMBER
Name	:	WILLIAM BOYAN
Credential	:	MD
Telephone Number	:	206-842-2379

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	02/08/2010

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