Basic Information
| Provider Information | |||||||||
| NPI: | 1770592677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538742227 | ||||||||
| FaxNumber: | 2538358000 | ||||||||
| Practice Location | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538742227 | ||||||||
| FaxNumber: | 2538358000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00027955 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8935075 | 01 | WA | CRIME VICTIMS | OTHER | 1094838 | 05 | WA | MEDICAID | 126683 | 01 | WA | L & I | OTHER | 110185075 | 01 | WA | RAILROAD | OTHER |