Individual
DR. SAMUEL MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
510 8TH AVE NE STE 200, ISSAQUAH, WA 98029-5436
(425) 392-3030
(425) 392-2564
Mailing address
510 8TH AVE NE STE 320, ISSAQUAH, WA 98029-5436
(425) 392-3030
(425) 392-2564
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD61435678
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD61435678
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2082179
—
WA
Enumeration date
04/12/2017
Last updated
10/18/2023
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