Organization
SOUTH WHIDBEY PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN WAGNER (OFFICE MANAGER)
(360) 331-1314
Entity
Organization
Contact information
Practice address
1690 LAYTON RD, FREELAND, WA 98249-9456
(360) 331-1314
Mailing address
PO BOX 8, FREELAND, WA 98249
(360) 331-1314
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00020537
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7090517
—
WA
Enumeration date
06/04/2010
Last updated
06/04/2010
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