Provider Demographics
NPI:1659359586
Name:JOSAFAT, ALICE BROWN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:BROWN
Last Name:JOSAFAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:FRANCES
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000435402085R0202X
IDM-123102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1659359586Medicaid
WA184782OtherLNI PROVIDER ID
WA184784OtherLNI PROVIDER ID
WA8392581Medicaid
WA184783OtherLNI PROVIDER ID
WA204108OtherLNI PROVIDER ID
WA8392581Medicaid
ID1659359586Medicaid
WAG8857938Medicare PIN
WA204108OtherLNI PROVIDER ID
WAP00358465Medicare PIN
WAP01165540Medicare PIN
WA184784OtherLNI PROVIDER ID
WAH90527Medicare UPIN
WAP00363385Medicare PIN
WAG8803130Medicare PIN
WAG8803132Medicare PIN
ID20004924Medicare PIN