Healthcare Provider Details

I. General information

NPI: 1467714022
Provider Name (Legal Business Name): PAUL A WARDROP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 SUMMITVIEW AVE
YAKIMA WA
98908-2858
US

IV. Provider business mailing address

5109 SUMMITVIEW AVE
YAKIMA WA
98908-2858
US

V. Phone/Fax

Practice location:
  • Phone: 509-907-6300
  • Fax:
Mailing address:
  • Phone: 509-907-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60488613
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60488613
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: