Basic Information
| Provider Information | |||||||||
| NPI: | 1215135561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOFIE | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | ESTELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FOFIE | ||||||||
| OtherFirstName: | ANITA | ||||||||
| OtherMiddleName: | AFUA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2415 WESTERN AVE | ||||||||
| Address2: | APT #503 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981211394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062258875 | ||||||||
| FaxNumber: | 2064436599 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981224379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063862123 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ML20009130 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.