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General NPI Number Information
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NPI Number | 1659241875
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Entity Type | Organization
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Legal Business Name | WESTERN WASHINGTON MEDICAL GROUP INC PS
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 12728 19TH AVE SE STE 300
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City | EVERETT
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State | WA
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Zip | 98208-6676
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Country | US
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Telephone | 425-212-3130
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Fax | 425-320-1187
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Provider Business Mailing Address
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Address Line | 1728 W MARINE VIEW DR STE 110
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City | EVERETT
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State | WA
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Zip | 98201-2094
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Country | US
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Telephone | 425-259-4041
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Fax | 425-320-1187
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Authorized Official
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Title or Position | CEO
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Name | DAVID RUSSIAN
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Credential | MD
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Telephone | 425-259-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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