# EASTSIDE ENDOCRINOLOGY AND DIABETES, PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861493272
- **Authorized official:** DR. BRADLEY JOY WALLUM MD (OWNER)
- **Authorized official phone:** (425) 453-9762

## Contact information

- **Practice address:** 2020 116TH AVE NE, SUITE 150, BELLEVUE, WA 98004-3059
- **Practice address phone:** (425) 453-9762
- **Practice address fax:** (425) 455-5953
- **Mailing address:** 2020 116TH AVE NE, SUITE 150, BELLEVUE, WA 98004-3059
- **Mailing address phone:** (425) 453-9762
- **Mailing address fax:** (425) 455-5953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | MD00024156 | WA | Yes |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 01/15/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1022656 | — | WA |