Basic Information
Provider Information
NPI: 1356393441
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARTERBURN
FirstName: DAVID
MiddleName: ERIC
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34584
Address2:  
City: SEATTLE
State: WA
PostalCode: 981241584
CountryCode: US
TelephoneNumber: 5092417349
FaxNumber:  
Practice Location
Address1: 125 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125211
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2006
LastUpdateDate: 11/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD00039925WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
829626105WA MEDICAID


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