Provider Demographics
NPI:1427073717
Name:FOSMIRE, DANIEL PERRY (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PERRY
Last Name:FOSMIRE
Suffix:
Gender:M
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:PO BOX 94568
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6868
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-709-7055
Practice Address - Fax:425-709-7066
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037143207T00000X
WAMD00371432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8238685Medicaid
WA4491936OtherAETNA
WA0182685OtherL & I WORKERS COMP
WA5368FOOtherREGENCE BLUESHIELD
WA8930609OtherL & I CRIME VICTIMS
WA21171261225OtherUNIFORM MEDICAL PLAN
WA1223348 08OtherUNITED HEALTHCARE
WA770614555OtherTRIWEST
WA8930609OtherL & I CRIME VICTIMS
WAG8802338Medicare PIN
WAP00145132Medicare PIN