Provider Demographics
NPI:1356497275
Name:GOVIER, FRED E (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:E
Last Name:GOVIER
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 1:1100 9TH AVE
Mailing Address - Street 2:MS M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-583-6025
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024585208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001252081OtherSNOHOMISH COUNTY MC
WA340008895OtherRAILROAD MC
ID805276000Medicaid
WA000183704OtherKING COUNTY MC
WAGO7560OtherBLUE SHIELD #
WAUS0861551OtherAETNA SPECIALIST PIN
WA1032069Medicaid
AKMD245WAMedicaid
WA0039595OtherLABOR AND INDUSTRIES #
WA0039595OtherLABOR AND INDUSTRIES #
AKMD245WAMedicaid
A06180Medicare UPIN