Provider Demographics
NPI:1124181599
Name:HALLOCK, ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 165TH AVE NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6628
Mailing Address - Country:US
Mailing Address - Phone:206-949-7371
Mailing Address - Fax:
Practice Address - Street 1:8250 165TH AVE NE
Practice Address - Street 2:SUITE 210
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6628
Practice Address - Country:US
Practice Address - Phone:206-949-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00000369352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA158200Medicare ID - Type Unspecified
WAG85754Medicare UPIN