Provider Demographics
NPI:1366597932
Name:SEATTLE REPRODUCTIVE MEDICINE
Entity type:Organization
Organization Name:SEATTLE REPRODUCTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-301-5001
Mailing Address - Street 1:1505 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3050
Mailing Address - Country:US
Mailing Address - Phone:206-301-5000
Mailing Address - Fax:206-285-4555
Practice Address - Street 1:1505 WESTLAKE AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3050
Practice Address - Country:US
Practice Address - Phone:206-301-5000
Practice Address - Fax:206-285-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602352899261QA0006X
207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility FacilityGroup - Single Specialty