Provider Demographics
NPI:1043408537
Name:NORTHWEST AESTHETIC SURGEONS INC
Entity Type:Organization
Organization Name:NORTHWEST AESTHETIC SURGEONS INC
Other - Org Name:WHIDBEY PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SLEPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-678-2128
Mailing Address - Street 1:107 S MAIN ST STE D101
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3547
Mailing Address - Country:US
Mailing Address - Phone:360-678-2128
Mailing Address - Fax:360-678-1878
Practice Address - Street 1:107 S MAIN ST STE D101
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3547
Practice Address - Country:US
Practice Address - Phone:360-678-2128
Practice Address - Fax:360-678-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011222208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB39610Medicare PIN