Provider Demographics
NPI:1427294677
Name:TREEHOUSE PEDIATRICS LLC
Entity type:Organization
Organization Name:TREEHOUSE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUXBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-376-7337
Mailing Address - Street 1:429 MADRONA ST
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-8573
Mailing Address - Country:US
Mailing Address - Phone:360-376-7337
Mailing Address - Fax:888-543-7977
Practice Address - Street 1:429 MADRONA ST
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8573
Practice Address - Country:US
Practice Address - Phone:360-376-7337
Practice Address - Fax:888-543-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60027949208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty