Provider Demographics
NPI:1689655680
Name:MURTI, GUDRUN GERTRUD MARGARETA (MD)
Entity Type:Individual
Prefix:DR
First Name:GUDRUN
Middle Name:GERTRUD MARGARETA
Last Name:MURTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 NW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4637
Mailing Address - Country:US
Mailing Address - Phone:206-361-5583
Mailing Address - Fax:206-361-5583
Practice Address - Street 1:15230 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7130
Practice Address - Country:US
Practice Address - Phone:206-361-3577
Practice Address - Fax:206-361-5246
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8204042OtherDSHS
WAOTH 000Medicare UPIN