Provider Demographics
NPI:1972663698
Name:HOM, DENIS J (MD)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:J
Last Name:HOM
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 1:4700 36TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2716
Mailing Address - Country:US
Mailing Address - Phone:206-938-4291
Mailing Address - Fax:206-938-2078
Practice Address - Street 1:4700 36TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2716
Practice Address - Country:US
Practice Address - Phone:206-938-4291
Practice Address - Fax:206-938-2078
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB15636Medicare ID - Type Unspecified
WAA06820Medicare UPIN