Basic Information
Provider Information
NPI: 1255363685
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: WENDALL
MiddleName: W
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 805 MADISON ST
Address2: SUITE 901
City: SEATTLE
State: WA
PostalCode: 981041172
CountryCode: US
TelephoneNumber: 2062648100
FaxNumber: 2062648689
Practice Location
Address1: 3801 5TH ST SE
Address2: SUITE 110
City: PUYALLUP
State: WA
PostalCode: 983742106
CountryCode: US
TelephoneNumber: 2538459585
FaxNumber: 2534354785
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 10/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XS0117XMD00028543WAY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine

No ID Information.


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