Healthcare Provider Details

I. General information

NPI: 1215180864
Provider Name (Legal Business Name): ERIC T WATERMAN MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 TALBOT RD S STE 311
RENTON WA
98055-6238
US

IV. Provider business mailing address

PO BOX 59532
RENTON WA
98058-2532
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4200
  • Fax: 425-656-4258
Mailing address:
  • Phone: 425-656-4200
  • Fax: 425-656-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00029408
License Number StateWA

VIII. Authorized Official

Name: DR. ERIC T WATERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 425-656-4200