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Organization

PHD2 OF SNOHOMISH COUNTY

Active
Other names
Stevens Center for Internal Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY L. WANGSMO (CHIEF FINANCIAL OFFICER)
(425) 640-4113
Entity
Organization

Contact information

Practice address
7320 216TH ST SW, SUITE 200, EDMONDS, WA 98026-8006
(425) 640-4901
(425) 640-4919
Mailing address
7320 216TH ST SW, SUITE 200, EDMONDS, WA 98026-8006
(425) 640-4901
(425) 640-4919

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
35870
LABOR AND INDUSTRIES
WA
05
7059371
WA
01
CG1766
MEDICARE RAILROAD GROUP
WA
01
CJ4104
MEDICARE RAILROAD GROUP
WA
01
DB5880
MEDICARE RAILROAD GROUP
WA
01
DE0413
MEDICARE RAILROAD GROUP
WA
Enumeration date
04/06/2006
Last updated
12/10/2007
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