Provider Demographics
NPI:1790778793
Name:GOTTLIEB, DANIEL W (MD PS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66596
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0596
Mailing Address - Country:US
Mailing Address - Phone:206-241-7146
Mailing Address - Fax:
Practice Address - Street 1:16122 8TH AVE SW STE D1
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2967
Practice Address - Country:US
Practice Address - Phone:206-241-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021018207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA060009854OtherRR MEDICARE
WA1001585Medicaid
WA060009854OtherRR MEDICARE
WA1001585Medicaid