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Organization
SEATTLE SPORTS & REGENERATIVE MEDICINE PLLC
Active
Organization
SEATTLE SPORTS & REGENERATIVE MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D WAGNER MD (OWNER)
(206) 999-8556
Entity
Organization
Contact information
Practice address
1000 DEXTER AVE N STE 320, SEATTLE, WA 98109-4878
(206) 999-8556
Mailing address
1000 DEXTER AVE N STE 320, SEATTLE, WA 98109-4878
(206) 486-7837
(206) 462-7520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00022633
WA
Other
Enumeration date
05/18/2017
Last updated
10/07/2021
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