MEDICARE: KENNETH D SAWYER MD CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD00019863	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295928323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH D SAWYER MD CORP

Provider Business Mailing Address
First Line	:	PO BOX 97115
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98497-0115
Country	:	US
Telephone Number	:	253-588-7911
Fax Number	:	253-984-6774

Provider Business Practice Location Address
First Line	:	875 WESLEY ST
Second Line	:	SUITE 210
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1613
Country	:	US
Telephone Number	:	360-403-8158
Fax Number	:	360-403-7098

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH D SAWYER
Credential	:	MD PS
Telephone Number	:	253-588-7911

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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