Provider Demographics
NPI:1306838271
Name:OLLIFFE, JEFFREY FRED (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:FRED
Last Name:OLLIFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 12TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-624-6104
Mailing Address - Fax:206-724-0618
Practice Address - Street 1:1817 12TH AVENUE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-624-6104
Practice Address - Fax:206-724-0618
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA080013515OtherRAILROAD MEDICARE #
WA4079498OtherAETNA PROVIDER NUMBER
WAOL5050OtherREGENCE PROVIDER NUMBER
WA57243OtherL & I PROVIDER #
WA1019371Medicaid
WA1019371Medicaid
WA4079498OtherAETNA PROVIDER NUMBER