Basic Information
| Provider Information | |||||||||
| NPI: | 1447207659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUERBACH | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | CHRISTINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 LIND AVE SW | ||||||||
| Address2: | SUITE 100 ATTN CREDENTIALING | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980574970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256902715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10555 SE CARR RD BLDG M | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256903470 | ||||||||
| FaxNumber: | 4256909470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00039457 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4554AU | 01 | WA | BLUE SHIELD # | OTHER | 0039581 | 01 | WA | LABOR AND INDUSTRIES # | OTHER | 1056504 | 05 | WA | MEDICAID | 8500597 | 05 | WA | MEDICAID | G8873600 | 01 | MEDICARE NUMBER FOR WINSLOW LOCATION | OTHER | G8979445 | 01 | WA | MEDICARE | OTHER | G8979445 | 01 | WA | MEDICARE W VALLEY MEDICAL GROUP - RENTON | OTHER |