MEDICARE: DR. DAVID DOUGLAS ASMUSSEN D.O.

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	208D00000X	General Practice Physician	OP00000658	WA

General Provider Information

NPI Number	:	1780738534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DOUGLAS ASMUSSEN D.O.

Provider Business Mailing Address
First Line	:	14704 EDGEWATER LN NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-7729
Country	:	US
Telephone Number	:	425-443-2213
Fax Number	:

Provider Business Practice Location Address
First Line	:	14704 EDGEWATER LN NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-7729
Country	:	US
Telephone Number	:	425-443-2213
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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