Provider Demographics
NPI:1154853703
Name:DERMATOLOGY ASSOCIATES OF SEATTLE PS
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF SEATTLE PS
Other - Org Name:DERMATOLOGY ASSOCIATES OF SEATTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-267-2100
Mailing Address - Street 1:1730 MINOR AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1498
Mailing Address - Country:US
Mailing Address - Phone:206-267-2100
Mailing Address - Fax:206-267-2101
Practice Address - Street 1:1730 MINOR AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1498
Practice Address - Country:US
Practice Address - Phone:206-267-2100
Practice Address - Fax:206-267-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037526207N00000X, 207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty