Provider Demographics
NPI:1558486969
Name:CEDAR MEDICAL SPECIALTIES, PLLC
Entity Type:Organization
Organization Name:CEDAR MEDICAL SPECIALTIES, PLLC
Other - Org Name:AESTHETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-627-2900
Mailing Address - Street 1:2202 S CEDAR ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2318
Mailing Address - Country:US
Mailing Address - Phone:253-627-2900
Mailing Address - Fax:253-627-2941
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:SUITE 230
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-627-2900
Practice Address - Fax:253-627-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB25810Medicare ID - Type Unspecified