Individual
KENNETH MURRAY EDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 3RD ST SE, SUITE 200, PUYALLUP, WA 98372-4511
(253) 840-4444
(253) 840-5239
Mailing address
1701 3RD ST SE, SUITE 200, PUYALLUP, WA 98372-4511
(253) 840-4444
(253) 840-5239
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD00026074
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7085020
—
WA
Enumeration date
09/06/2006
Last updated
06/15/2012
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