Provider Demographics
NPI:1003945643
Name:SEMON, RICHARD L (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:SEMON
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 1:720 OLIVE WAY
Mailing Address - Street 2:SUITE 1505
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1878
Mailing Address - Country:US
Mailing Address - Phone:206-838-2590
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:1100 PACIFIC AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4261
Practice Address - Country:US
Practice Address - Phone:425-339-2433
Practice Address - Fax:425-339-8273
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014735207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115121304Medicare ID - Type Unspecified
WA8866155Medicare PIN
WAA09193Medicare UPIN
WAG8877623Medicare PIN