Basic Information
Provider Information
NPI: 1306817358
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AULD
FirstName: MERRITT
MiddleName: KEVIN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: AULD
OtherFirstName: M.
OtherMiddleName: KEVIN
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 5
Mailing Information
Address1: 805 MADISON ST
Address2: SUITE 901
City: SEATTLE
State: WA
PostalCode: 981041172
CountryCode: US
TelephoneNumber: 2062648100
FaxNumber:  
Practice Location
Address1: 601 BROADWAY
Address2: 6TH FLOOR
City: SEATTLE
State: WA
PostalCode: 981225330
CountryCode: US
TelephoneNumber: 2063862600
FaxNumber: 2066221644
Other Information
ProviderEnumerationDate: 01/29/2006
LastUpdateDate: 12/12/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XMD00023514WAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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