Healthcare Provider Details

I. General information

NPI: 1689790792
Provider Name (Legal Business Name): DEL WHETSTONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9629 EVERGREEN WAY SUITE 102
EVERETT WA
98204-7198
US

IV. Provider business mailing address

9629 EVERGREEN WAY SUITE 102
EVERETT WA
98204-7198
US

V. Phone/Fax

Practice location:
  • Phone: 425-353-6755
  • Fax: 425-953-9848
Mailing address:
  • Phone: 425-353-6755
  • Fax: 425-953-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001171
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: