Individual
BENJAMIN LIDGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104-2420
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60959121
WA
207RN0300X
Nephrology Physician
Primary
MD60959121
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417319484
—
WA
Enumeration date
03/28/2016
Last updated
05/03/2021
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