Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PMG NW WA Reconstructive & Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
12800 BOTHELL EVERETT HWY, SUITE 260, EVERETT, WA 98208-6642
(425) 316-5080
(425) 316-5025
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(425) 358-9786
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
10/07/2008
Last updated
05/09/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us