Provider Demographics
NPI:1629092705
Name:TESLER, ALAN S (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:TESLER
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 3713
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3713
Mailing Address - Country:US
Mailing Address - Phone:206-749-5130
Mailing Address - Fax:206-749-5135
Practice Address - Street 1:16233 SYLVESTER ROAD SW, SUITE 120
Practice Address - Street 2:C/O SWEDISH CANCER INSTITUTE @ HIGHLINE
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-386-2626
Practice Address - Fax:206-246-7344
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000222222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1005115Medicaid
WA8808519Medicare PIN
WA1005115Medicaid