Provider Demographics
NPI:1861577223
Name:PEPPER, ELLENDEE (MD)
Entity type:Individual
Prefix:
First Name:ELLENDEE
Middle Name:
Last Name:PEPPER
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:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-228-3440
Mailing Address - Fax:
Practice Address - Street 1:660 SW 39TH ST
Practice Address - Street 2:STE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4912
Practice Address - Country:US
Practice Address - Phone:425-793-4700
Practice Address - Fax:425-656-4046
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022801207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA070011908OtherRR MEDICARE
WA1008770Medicaid
WA0123182OtherL&I
WAPE0386OtherREGENCE
WAPE0386OtherREGENCE
WA1008770Medicaid