Provider Demographics
NPI:1225278955
Name:PERCIVAL, MARY-ELIZABETH MUCHMORE (MD)
Entity Type:Individual
Prefix:
First Name:MARY-ELIZABETH
Middle Name:MUCHMORE
Last Name:PERCIVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY-ELIZABETH
Other - Middle Name:ANSELMO
Other - Last Name:MUCHMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX 358081 / MS G6-075
Mailing Address - Street 2:UNIVERSITY OF WASHINGTON
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:SEATTLE CANCER CARE ALLIANCE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-598-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106581207R00000X, 207RH0003X
WAMD.MD.60591746207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology