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Organization
EASTSIDE ENDOCRINOLOGY AND DIABETES, PS
Active
Organization
EASTSIDE ENDOCRINOLOGY AND DIABETES, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY JOY WALLUM MD (OWNER)
(425) 453-9762
Entity
Organization
Contact information
Practice address
2020 116TH AVE NE, SUITE 150, BELLEVUE, WA 98004-3059
(425) 453-9762
(425) 455-5953
Mailing address
2020 116TH AVE NE, SUITE 150, BELLEVUE, WA 98004-3059
(425) 453-9762
(425) 455-5953
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD00024156
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022656
—
WA
Enumeration date
08/09/2005
Last updated
01/15/2010
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