Healthcare Provider Details

I. General information

NPI: 1013297969
Provider Name (Legal Business Name): WALTER PAGAN LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 30TH AVE SW
SEATTLE WA
98126-2301
US

IV. Provider business mailing address

3225 30TH AVE SW
SEATTLE WA
98126-2301
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-0234
  • Fax:
Mailing address:
  • Phone: 206-659-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA60183933
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: