Basic Information
Provider Information
NPI: 1386843746
EntityType: 2
ReplacementNPI:  
OrganizationName: BELLEVUE SURGERY ASSOC PC
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Mailing Information
Address1: 1135 116TH AVE NE
Address2: SUITE 550
City: BELLEVUE
State: WA
PostalCode: 980044623
CountryCode: US
TelephoneNumber: 4256881916
FaxNumber: 4256881901
Practice Location
Address1: 1135 116TH AVE NE
Address2: SUITE 550
City: BELLEVUE
State: WA
PostalCode: 980044623
CountryCode: US
TelephoneNumber: 4256881916
FaxNumber: 4256881901
Other Information
ProviderEnumerationDate: 07/16/2007
LastUpdateDate: 02/25/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: ELGHAZZAWY
AuthorizedOfficialFirstName: ADEL
AuthorizedOfficialMiddleName: G
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4256881916
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XMD00039270WAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
827457305WA MEDICAID
014609501WADEPT OF L&IOTHER
6942EL01WAREGENCE BLUE SHIELDOTHER


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