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General NPI Number Information
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NPI Number | 1013979624
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Entity Type | Organization
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Legal Business Name | PHD2 OF SNOHOMISH COUNTY
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 7320 216TH ST SW SUITE 200
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City | EDMONDS
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State | WA
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Zip | 98026-8006
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Country | US
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Telephone | 425-640-4901
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Fax | 425-640-4919
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Provider Business Mailing Address
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Address Line | 7320 216TH ST SW SUITE 200
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City | EDMONDS
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State | WA
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Zip | 98026-8006
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Country | US
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Telephone | 425-640-4901
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Fax | 425-640-4919
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. GARY L. WANGSMO
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Credential |
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Telephone | 425-640-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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