Individual
SHAWN ERIK TEDFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1225 CAMPBELL WAY STE 201, BREMERTON, WA 98310-3323
(360) 377-1355
Mailing address
1225 CAMPBELL WAY STE 201, BREMERTON, WA 98310-3323
(360) 377-1355
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003756
WA
363A00000X
Physician Assistant
PA2007-0004
NM
363AM0700X
Medical Physician Assistant
PA2007-0004
NM
363AS0400X
Surgical Physician Assistant
PA2007-0004
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001498
—
WA
01
—
205198
LABOR & INDUSTRIES
WA
01
—
8918TE
REGENCE BLUESHIELD
—
01
—
8942304
CRIME VICTIMS COMP
WA
01
—
P00330803
RAILROAD MEDICARE
—
Enumeration date
06/26/2006
Last updated
03/07/2023
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