Provider Demographics
NPI:1407023930
Name:DEBORAH S. GOLOB, MD PLLC
Entity type:Organization
Organization Name:DEBORAH S. GOLOB, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GOLOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-454-0526
Mailing Address - Street 1:1603 116TH AVE NE
Mailing Address - Street 2:STE 112
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3009
Mailing Address - Country:US
Mailing Address - Phone:425-454-0526
Mailing Address - Fax:425-455-0076
Practice Address - Street 1:1603 116TH AVE NE
Practice Address - Street 2:STE 112
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:425-454-0526
Practice Address - Fax:425-455-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044606261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty