Provider Demographics
NPI:1467537365
Name:CONKLIN, EDWARD RANSFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RANSFORD
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:RANSFORD
Other - Last Name:CONKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1601 5TH AVE STE 830
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3621
Mailing Address - Country:US
Mailing Address - Phone:206-624-6051
Mailing Address - Fax:206-623-7674
Practice Address - Street 1:1601 5TH AVE STE 830
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3621
Practice Address - Country:US
Practice Address - Phone:206-624-6051
Practice Address - Fax:206-623-7674
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA32003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA32003OtherSTATE LICENSE NUMBER
8853147Medicare PIN
WAF621544Medicare UPIN