1003181942 NPI number — MR. ADAM CHRISTOPHER PAZDER R.D.

Table of content: MR. ADAM CHRISTOPHER PAZDER R.D. (NPI 1003181942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003181942 NPI number — MR. ADAM CHRISTOPHER PAZDER R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAZDER
Provider First Name:
ADAM
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003181942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22607 141ST AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-3846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-350-4477
Provider Business Mailing Address Fax Number:
253-630-1192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SW 39TH ST
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-264-2584
Provider Business Practice Location Address Fax Number:
425-264-2569
Provider Enumeration Date:
03/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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