Provider Demographics
NPI:1467421610
Name:BOUDOUSQUIE, ALAN CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CURTIS
Last Name:BOUDOUSQUIE
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:PO BOX 3941
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3941
Mailing Address - Country:US
Mailing Address - Phone:206-386-2676
Mailing Address - Fax:206-386-2709
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4306
Practice Address - Country:US
Practice Address - Phone:206-386-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85573207ZC0500X, 207ZP0102X
WAMD00033212207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203961OtherLABOR & INDUSTRIES
WA8377129Medicaid
WA203961OtherLABOR & INDUSTRIES
WAG8855808Medicare PIN
WA8377129Medicaid
WAP00292035Medicare PIN