Healthcare Provider Details

I. General information

NPI: 1770645053
Provider Name (Legal Business Name): NORTHWEST GASTROENTEROLOGY ASSOCIATES, INC., P.S,.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE SUITE 560
BELLEVUE WA
98004-4623
US

IV. Provider business mailing address

1135 116TH AVE NE SUITE 560
BELLEVUE WA
98004-4623
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax: 425-462-8021
Mailing address:
  • Phone: 425-454-4768
  • Fax: 425-462-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A WOHLMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 425-990-2721