Organization
EASTSIDE ENDOCRINOLOGY AND DIABETES, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY JOY WALLUM MD (OWNER)
(425) 453-9762
Entity
Organization
Contact information
Practice address
2020 116TH AVE NE, SUITE 150, BELLEVUE, WA 98004-3059
(425) 453-9762
(425) 455-5953
Mailing address
2020 116TH AVE NE, SUITE 150, BELLEVUE, WA 98004-3059
(425) 453-9762
(425) 455-5953
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD00024156
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022656
—
WA
Enumeration date
08/09/2005
Last updated
01/15/2010
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