Provider Demographics
NPI:1770760746
Name:JEFFREY F OLLIFFE, M.D.
Entity type:Organization
Organization Name:JEFFREY F OLLIFFE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-1441
Mailing Address - Street 1:1120 CHERRY ST
Mailing Address - Street 2:SUITE: 320
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2044
Mailing Address - Country:US
Mailing Address - Phone:206-624-6104
Mailing Address - Fax:
Practice Address - Street 1:1120 CHERRY ST
Practice Address - Street 2:SUITE: 320
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2044
Practice Address - Country:US
Practice Address - Phone:206-624-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4079498OtherAETNA
WA57243OtherL&I
WA1019371Medicaid
WAOL5050OtherREGENCE BLUE SHIELD
WAA06178Medicare UPIN