Longevity Medical Clinic

NPI #1023231172 in Kirkland, Washington

Provider Information

NPI Number: 1023231172
Entity Type: Organization
Organization Name: Longevity Medical Clinic
Primary Specialty: Specialist
Enumeration Date: Apr 10, 2007
Last Updated: Jun 21, 2011

Practice Location

Address: 9757 NE JUANITA DR
Address 2: SUITE 200
City: Kirkland
State: Washington
ZIP Code: 98034-4299
Phone: (425) 576-9272

Authorized Official

Name: DR. JERRY N MIXON, M.D.
Title: MEDICAL DIRECTOR
Phone: (425) 576-9272

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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