Provider Demographics
NPI:1619984143
Name:ARNOLD, PHILLIP BONNER (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BONNER
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 MERIDICAN AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8967
Mailing Address - Country:US
Mailing Address - Phone:206-525-5777
Mailing Address - Fax:206-528-9881
Practice Address - Street 1:11011 MERIDICAN AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8967
Practice Address - Country:US
Practice Address - Phone:206-525-5777
Practice Address - Fax:206-528-9881
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44658207Q00000X
WAOP60440021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43527900Medicaid
WAG8948275Medicare PIN
I25663Medicare UPIN