Provider Demographics
NPI:1982659959
Name:NORTHWEST EAR, NOSE & THROAT, PLLC
Entity Type:Organization
Organization Name:NORTHWEST EAR, NOSE & THROAT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:GLYNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-352-5705
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9451
Mailing Address - Country:US
Mailing Address - Phone:206-389-7100
Mailing Address - Fax:206-389-7101
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 190
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-389-7100
Practice Address - Fax:206-389-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8803791Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER