Provider Demographics
NPI:1144316977
Name:ANAWALT, BRADLEY DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVID
Last Name:ANAWALT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7217 36TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3218
Mailing Address - Country:US
Mailing Address - Phone:206-764-2345
Mailing Address - Fax:206-764-2903
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:VA PUGET SOUND
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108
Practice Address - Country:US
Practice Address - Phone:206-764-2345
Practice Address - Fax:206-764-2903
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA28736207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism