Provider Demographics
NPI:1427046473
Name:BALOGUN, ANIFAT O (MD)
Entity type:Individual
Prefix:
First Name:ANIFAT
Middle Name:O
Last Name:BALOGUN
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 1:6850 35TH AVE NE
Mailing Address - Street 2:STE 4
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7344
Mailing Address - Country:US
Mailing Address - Phone:206-525-0903
Mailing Address - Fax:866-497-3901
Practice Address - Street 1:6850 35TH AVE NE
Practice Address - Street 2:STE 4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7344
Practice Address - Country:US
Practice Address - Phone:206-525-0903
Practice Address - Fax:866-497-3901
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039276207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8264525Medicaid
WA5618BAOtherREGENCE
WA611494859OtherTAX ID
WA8264525Medicaid
WA611494859OtherTAX ID