Basic Information
Provider Information
NPI: 1295928323
EntityType: 2
ReplacementNPI:  
OrganizationName: KENNETH D SAWYER MD CORP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: PO BOX 97115
Address2:  
City: LAKEWOOD
State: WA
PostalCode: 984970115
CountryCode: US
TelephoneNumber: 2535887911
FaxNumber: 2539846774
Practice Location
Address1: 875 WESLEY ST
Address2: SUITE 210
City: ARLINGTON
State: WA
PostalCode: 982231613
CountryCode: US
TelephoneNumber: 3604038158
FaxNumber: 3604037098
Other Information
ProviderEnumerationDate: 08/22/2007
LastUpdateDate: 08/22/2007
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SAWYER
AuthorizedOfficialFirstName: KENNETH
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 2535887911
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD PS
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XMD00019863WAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
112324905WA MEDICAID


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