Basic Information
| Provider Information | |||||||||
| NPI: | 1093768111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33501 1ST WAY S | ||||||||
| Address2: | MS:A-SO | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538382400 | ||||||||
| FaxNumber: | 2538741637 | ||||||||
| Practice Location | |||||||||
| Address1: | 33501 1ST WAY S | ||||||||
| Address2: | MS:A-SO | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538382400 | ||||||||
| FaxNumber: | 2538741637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 03/28/2017 | ||||||||
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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 | 207L00000X | MD00040006 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7476AL | 01 | WA | BLUE SHIELD # VM | OTHER | 8311250 | 05 | WA | MEDICAID | 0039515 | 01 | WA | LABOR AND INDUSTRIES # VM | OTHER | P00417104 | 01 | WA | RAILROAD MC # VM | OTHER |