Individual
BENGT OLOV WIDLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1321 COLBY AVE, EVERETT, WA 98201-1665
(425) 258-3678
(425) 258-3048
Mailing address
1721 HOLBROOK AVE, EVERETT, WA 98203-1623
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00021686
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0712WI
D/S REGENCE 90
—
05
—
1010511
—
WA
01
—
189645
L&I
—
Enumeration date
06/29/2006
Last updated
07/08/2007
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