Basic Information
| Provider Information | |||||||||
| NPI: | 1912154428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ETZKORN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 4TH AVE PLAZA | ||||||||
| Address2: | STE 420 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981541119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063203351 | ||||||||
| FaxNumber: | 2065547787 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 4TH AVE PLAZA | ||||||||
| Address2: | STE 420 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981541119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063203351 | ||||||||
| FaxNumber: | 2065547787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60149242 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.