Provider Demographics
NPI:1003250853
Name:MADEIRA, SAMUEL PHILIP (NMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PHILIP
Last Name:MADEIRA
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 5TH AVE STE 101-800
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3176
Mailing Address - Country:US
Mailing Address - Phone:206-779-7747
Mailing Address - Fax:406-846-5809
Practice Address - Street 1:100 WALL ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1423
Practice Address - Country:US
Practice Address - Phone:206-779-7747
Practice Address - Fax:406-846-5809
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60341050175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath