Provider Demographics
NPI:1801844022
Name:ENDOCRINE CONSULTANTS NORTHWEST I, PLLC
Entity Type:Organization
Organization Name:ENDOCRINE CONSULTANTS NORTHWEST I, PLLC
Other - Org Name:ENDOCRINE CONSULTANTS NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:K. DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-565-6777
Mailing Address - Street 1:1628 S MILDRED ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1627
Mailing Address - Country:US
Mailing Address - Phone:253-565-6777
Mailing Address - Fax:253-565-8777
Practice Address - Street 1:1628 S MILDRED ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1627
Practice Address - Country:US
Practice Address - Phone:253-565-6777
Practice Address - Fax:253-565-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RE0101X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB03009Medicare PIN