Provider Demographics
NPI:1144329103
Name:WATANABE, BARBARA Y (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:Y
Last Name:WATANABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:Y
Other - Last Name:WANTANABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1112 6TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4040
Mailing Address - Country:US
Mailing Address - Phone:866-284-5033
Mailing Address - Fax:
Practice Address - Street 1:34515 9TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-588-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022121207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8120065Medicaid
WAGAB29171Medicare PIN
E17495Medicare UPIN