Provider Demographics
NPI:1053335315
Name:ZUMWALT, THERESA ANN (MD FACOG)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:ZUMWALT
Suffix:
Gender:F
Credentials:MD FACOG
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:ZUMWALT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10355 NE VALLEY RD #4716
Mailing Address - Street 2:
Mailing Address - City:ROLLINGBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98061-0716
Mailing Address - Country:US
Mailing Address - Phone:206-842-5999
Mailing Address - Fax:206-780-7788
Practice Address - Street 1:14991 SUNRISE DRIVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-5999
Practice Address - Fax:206-780-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54501207VG0400X
WAMD00036846207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8236663Medicaid
A52732Medicare UPIN