Provider Demographics
NPI:1508890138
Name:HOUSEWORTH, TROY PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:PATRICK
Last Name:HOUSEWORTH
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 1:1600 116TH AVE NE STE 304
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3057
Mailing Address - Country:US
Mailing Address - Phone:425-453-7888
Mailing Address - Fax:425-453-7899
Practice Address - Street 1:1600 116TH AVE NE STE 304
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3057
Practice Address - Country:US
Practice Address - Phone:425-453-7888
Practice Address - Fax:425-453-7899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041587208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33025FMedicare PIN
WAG8880508Medicare PIN