Healthcare Provider Details

I. General information

NPI: 1033190889
Provider Name (Legal Business Name): SEATTLE HAND SURGERY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY SUITE 440
SEATTLE WA
98122
US

IV. Provider business mailing address

600 BROADWAY SUITE 440
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6252
  • Fax: 206-292-7893
Mailing address:
  • Phone: 206-292-6252
  • Fax: 206-292-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: MR. WILLIAM F WAGNER JR.
Title or Position: VP
Credential: MD
Phone: 206-292-6252