Basic Information
| Provider Information | |||||||||
| NPI: | 1245524172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAPP | ||||||||
| FirstName: | ELLIOT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAPP | ||||||||
| OtherFirstName: | E. | ||||||||
| OtherMiddleName: | JAMES | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1959 NE PACIFIC ST # NW001 | ||||||||
| Address2: | BOX 357115 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981957115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065986483 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1959 NE PACIFIC ST # NW001 | ||||||||
| Address2: | BOX 357115 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981957115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065986483 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2011 | ||||||||
| LastUpdateDate: | 06/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 247742 | MA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.