Provider Demographics
NPI:1841302007
Name:GUILBERT, DAVIS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:ALAN
Last Name:GUILBERT
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:PO BOX 94624
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6924
Mailing Address - Country:US
Mailing Address - Phone:800-634-4064
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:11811 NE 128TH STREET
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7200
Practice Address - Country:US
Practice Address - Phone:425-821-3472
Practice Address - Fax:425-820-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0444522085R0202X
WAMD000482352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology