MEDICARE: JEFFREY BISSEY MD

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	207R00000X	Internal Medicine Physician	28595	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	:	1700840832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY BISSEY MD

Provider Business Mailing Address
First Line	:	PO BOX 5127
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98206-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15418 MAIN ST
Second Line	:	SUITE 200
City	:	MILL CREEK
State	:	WA
Zip	:	98012-9030
Country	:	US
Telephone Number	:	425-225-8002
Fax Number	:	425-225-8021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/01/2014

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