=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760566426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARREN J WARDLE DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 06/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7320 216TH ST SW STE 320B
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-775-6996
-----------------------------------------------------
Fax | 425-670-8905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7320 216TH ST SW STE 320
-----------------------------------------------------
City | EDMONDS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98026-8006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-673-3900
-----------------------------------------------------
Fax | 425-673-3910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO00000411
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------