Provider Demographics
NPI:1730152794
Name:HASSIG, WALTER M (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:M
Last Name:HASSIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33915 1ST WAY S STE 200
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33915 1ST WAY S STE 200
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6396
Practice Address - Country:US
Practice Address - Phone:253-272-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037341207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00037341OtherWA LICENSE
WA8240947Medicaid
WAG8851595Medicare PIN
WA8240947Medicaid
WA000188100Medicare PIN
WA8851594Medicare PIN
WA001045700Medicare PIN
WAAB09738Medicare PIN
WAG8880511Medicare PIN
WAMD00037341OtherWA LICENSE
WA100012749Medicare PIN
WAG8851594Medicare PIN
WAG8851597Medicare PIN