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NPI Code Detail

MEDICARE: EDWARD E WAKATAKE MD

MEDICARE: EDWARD E WAKATAKE MD
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
1207Q00000XFamily Medicine PhysicianMD00039599WA

General Provider Information

NPI Number : 1447284492
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD E WAKATAKE MD
Provider Business Mailing Address
First Line : 1007 39TH AVE SE
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-2192
Country : US
Telephone Number : 253-435-3100
Fax Number :
Provider Business Practice Location Address
First Line : 1007 39TH AVE SE
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-2192
Country : US
Telephone Number : 253-435-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 05/10/2021

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Directions to “ EDWARD E WAKATAKE MD” Practice Location

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