Healthcare Provider Details

I. General information

NPI: 1740377530
Provider Name (Legal Business Name): WAFIC A. MASSRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 S 5TH ST
TACOMA WA
98405
US

IV. Provider business mailing address

1003 S 5TH ST
TACOMA WA
98405-4210
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-2551
  • Fax:
Mailing address:
  • Phone: 253-403-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD45016
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: