Healthcare Provider Details

I. General information

NPI: 1598875882
Provider Name (Legal Business Name): WILLIAM RAYFORD GWIN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-5100
  • Fax:
Mailing address:
  • Phone: 206-543-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD60094874
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: