Provider Demographics
NPI:1174820666
Name:ROSSBOTHAM, DOMINIC K (RN-FIRST SURGICAL AS)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:K
Last Name:ROSSBOTHAM
Suffix:
Gender:M
Credentials:RN-FIRST SURGICAL AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19930 BALLINGER WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98155
Mailing Address - Country:US
Mailing Address - Phone:206-363-6947
Mailing Address - Fax:206-417-6947
Practice Address - Street 1:19930 BALLINGER WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98155
Practice Address - Country:US
Practice Address - Phone:206-363-6947
Practice Address - Fax:206-417-6947
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN001008993207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery