Provider Demographics
NPI:1649268210
Name:PORTUESE, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:PORTUESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3510
Mailing Address - Country:US
Mailing Address - Phone:206-624-6200
Mailing Address - Fax:206-624-0244
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:SUITE 1280
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3510
Practice Address - Country:US
Practice Address - Phone:206-624-6200
Practice Address - Fax:206-624-0244
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00028539207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8128381Medicaid
WA8128381Medicaid
WAG8866836Medicare PIN