Basic Information
Provider Information | |||||||||
NPI: | 1285696880 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WUTHRICH | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | AARON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 202 N DIVISION ST | ||||||||
Address2: | STE 201 | ||||||||
City: | AUBURN | ||||||||
State: | WA | ||||||||
PostalCode: | 980014939 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2539391230 | ||||||||
FaxNumber: | 2537351211 | ||||||||
Practice Location | |||||||||
Address1: | 202 N DIVISION ST | ||||||||
Address2: | STE 201 | ||||||||
City: | AUBURN | ||||||||
State: | WA | ||||||||
PostalCode: | 980014939 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2539391230 | ||||||||
FaxNumber: | 2537351211 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2006 | ||||||||
LastUpdateDate: | 04/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD00031931 | WA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 0280793 | 01 | WA | STATE L&I | OTHER | 0280783 | 01 | WA | STATE L&I | OTHER | 0301024 | 01 | WA | CONSOLIDATED L&I | OTHER | 8236143 | 05 | WA |   | MEDICAID | G8914770 | 01 | WA | MEDIXARE | OTHER | 0280795 | 01 | WA | STATE L&I | OTHER |