Basic Information
| Provider Information | |||||||||
| NPI: | 1699736579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIDON | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MORTON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MS 315010 | ||||||||
| Address2: | PO BOX 3947 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254673655 | ||||||||
| FaxNumber: | 4062578996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1135-116TH AVENUE NE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254542656 | ||||||||
| FaxNumber: | 4254552620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 12295 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | MD00033351 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2002512 | 05 | WA | MEDICAID |