Provider Demographics
NPI:1902875883
Name:DURKEE, NATHANIAL J (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:J
Last Name:DURKEE
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 94522
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6822
Mailing Address - Country:US
Mailing Address - Phone:952-542-8553
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:33801 FIRST WAY SOUTH
Practice Address - Street 2:SUITE 101
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6219
Practice Address - Country:US
Practice Address - Phone:253-942-7226
Practice Address - Fax:253-942-3517
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000437352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8401226Medicaid
WA8401226Medicaid