Provider Demographics
NPI:1881619591
Name:ISACKSON, REBECCA (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:ISACKSON
Suffix:
Gender:F
Credentials:DO
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 34936
Mailing Address - Street 2:DEPT 3028
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1936
Mailing Address - Country:US
Mailing Address - Phone:888-398-2473
Mailing Address - Fax:
Practice Address - Street 1:21601 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7507
Practice Address - Country:US
Practice Address - Phone:425-640-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001515207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA168566OtherL & I
910861251OtherPREMERA BLUE CROSS
SU0807OtherREGENCY BLUE SHIELD
A014OtherCHAMPUS
WA8234163Medicaid
F86186OtherGROUP HEALTH
F86186Medicare UPIN
001246200Medicare PIN
F86186OtherGROUP HEALTH
WA8234163Medicaid
930078658Medicare PIN
WA168566OtherL & I
CS1938Medicare PIN