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General NPI Number Information
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NPI Number | 1699162875
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Entity Type | Organization
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Legal Business Name | RONALD N. WALTZ, M.D., PLLC
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 21616 76TH AVE W SUITE 109
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City | EDMONDS
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State | WA
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Zip | 98026-7512
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Country | US
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Telephone | 425-670-6788
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Fax | 425-670-6795
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Provider Business Mailing Address
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Address Line | 21616 76TH AVE W SUITE 109
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City | EDMONDS
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State | WA
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Zip | 98026-7512
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Country | US
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Telephone | 425-670-6788
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Fax | 425-670-6795
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD NEWMAN WALTZ
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Credential | MD
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Telephone | 425-670-6788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00013996
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License Number State | WA
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