MEDICARE: FREMONT FAMILY PRACTICE LLC

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	207Q00000X	Family Medicine Physician	602228609	WA

General Provider Information

NPI Number	:	1871640581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREMONT FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	4464 FREMONT AVE N
Second Line	:	SUITE 103
City	:	SEATTLE
State	:	WA
Zip	:	98103-7273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6804 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5228
Country	:	US
Telephone Number	:	206-257-7380
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DAVID HARVEY
Credential	:
Telephone Number	:	206-257-7380

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/09/2022

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Directions to “FREMONT FAMILY PRACTICE LLC ” Practice Location

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