Provider Demographics
NPI:1265632988
Name:SAMPATACOS, NELS (MD)
Entity Type:Individual
Prefix:
First Name:NELS
Middle Name:
Last Name:SAMPATACOS
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 1:904 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-0001
Mailing Address - Country:US
Mailing Address - Phone:206-860-5578
Mailing Address - Fax:
Practice Address - Street 1:5125 OLYMPIC DR NW STE 110
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1712
Practice Address - Country:US
Practice Address - Phone:253-853-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008976208600000X
WAMD60366024207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery